Report of China City Adult Tobacco Survey
2013–14
A 14-city experience
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Disclaimer
Acknowledgments
Any reuse of this publication should not imply that the World Health Organization, Chinese Center for
Disease Control and Prevention, The International Union Against Tuberculosis and Lung Disease, Emory
Global Health Institute, and the CDC Foundation, hereinafter Partners, endorse any specific organization
or products. The use of the Partners’ names and logos is not permitted without written permission from
the Partners.
The designations employed and the presentation of the material in this publication do not imply the
expression of any opinion whatsoever on the part of the Partners concerning the legal status of any country,
territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted
lines on maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they
are endorsed or recommended by the Partners in preference to others of a similar nature that are not
mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial
capital letters.
All reasonable precautions have been taken by the Partners to verify the information contained in this
publication. However, the published material is being distributed without warranty of any kind, either
expressed or implied. The responsibility for the interpretation and use of the material lies with the reader.
In no event shall the Partners be liable for damages arising from its use.
The findings and conclusions in this report are those of the authors and do not necessarily represent the
official positions of the U.S. Centers for Disease Control and Prevention (CDC).
The mark “CDC” is owned by the U.S. Department of Health and Human Services (HHS) and is used with
permission. Use of this logo is not an endorsement by HHS or CDC of any particular product, service, or
enterprise.
First published in 2015
Maps, graphics and original concept copyright © Myriad Editions 2015
Myriad Editions
59 Lansdowne Place
Brighton BN3 1FL, UK
www.myriadeditions.com
Edited and coordinated by Jannet King and Candida Lacey
Designed by Isabelle Lewis
Maps and graphics created by Isabelle Lewis
Printed on paper produced from sustainable sources. Printed and bound in the People’s Republic of
China.
Suggested citation: Liang X (editor), Report of China City Adult Tobacco Survey 2013–14. 2015.
CDC Foundation, Atlanta, Georgia, USA.
ii
Funding for the China City Adult Tobacco Survey (CCATS) 2013–14 is
provided by Chinese Center for Disease Control and Prevention; the 14
participating cities; the CDC Foundation with support from the Bloomberg
Initiative to Reduce Tobacco Use with grants from the Bill & Melinda Gates
Foundation and Bloomberg Philanthropies; the International Union Against
Tuberculosis and Lung Disease; and Emory Global Health Institute.
We thank the implementing agencies of the 14 cities, the hundreds of field
workers for their contributions as well as the thousands of respondents for
their cooperation, without whom this work would not have been realized.
Finally, we are grateful to Rebecca Bunnell, Joanna Cohen, Shanna Cox,
Yixin Duan, Jennifer Ellis, Michael Eriksen, Kelly Henning, Jason Hsia, Brian
King, Lisa Lagasse, Ehsan Latif, Cynthia Lewis, Judith Mackay, Jean Paullin,
and Pamela Redmon for their expert reviews to improve the quality of this
report.
Contributors
Editor in Chief
Xiaofeng Liang
Vice Editors in Chief
Samira Asma, Yan Yang, Luhua Zhao, Yuan Jiang, Jijiang Wang
Writing Staff
Yi Nan, Yang Song, Jeremy Morton, Krishna M. Palipudi, Mengwu Tu, Lili Wang,
Lin Xiao, Jie Yang, Wei Ma, Leyu Niu, Chengjian Cao, Zhaokang Yuan, Fei Qi,
Juan Hong, Yong Wang, Meirong Yu, Zhaorui Xu, Miao Zhang, Ting Liu,
Xiurong Liu, Guohong Jiang
Expert Consultant Committee
Yu Wang, Qunan Mao, Gonghuan Yang, Qi Shi, Angela Pratt, Quan Gan, Yiqun Wu
Contents
Foreword I
vii
Foreword II
ix
Preface
xi
China City Adult Tobacco Survey (CCATS) 2013–14 Collaborative Group
xii
1 Introduction
1
2 Tobacco Smoking and E-Cigarette Use
7
3 Cessation
11
4 Secondhand Smoke Exposure
15
5 Tobacco Marketing and Anti-Tobacco Messages
19
6 Knowledge, Attitudes, and Perceptions
23
7 Cigarette Economics
27
8 Conclusions and Recommendations
29
9 City Profiles
33
Appendices
39
I: Data Tables, CCATS 2013 –14
40
II: Urban Areas Defined in the Survey in the 14 Participating Cities, CCATS 2013 –14
50
III: Local Regulations on Smoking in Indoor Public Places in the 14 Participating Cities,
CCATS 2013 –14
51
References
52
Photo Credits
52
Foreword I
The tobacco epidemic is one of the greatest public health challenges in the world. Six million
deaths annually are attributable to smoking, more than the combined number of deaths caused
by AIDS, tuberculosis and malaria. The Chinese government views tobacco control as a high
priority, and ratified the World Health Organization Framework Convention on Tobacco Control
(WHO FCTC). In order to synchronize the efforts to fulfill the WHO FCTC obligation, the InterMinistry Coordination Team for Implementing WHO FCTC was established, consisting of eight
government agencies, including the Ministry of Industry and Information, the National Health and
Family Planning Commission, and the Ministry of Foreign Affairs. The China Tobacco Control
Plan (2012–15) was developed, and tobacco control goals were included in the National Plan for
Chronic Diseases Prevention and Treatment.
Since 2007, China has undertaken a series of tobacco control advocacy and health education
efforts, focusing on creating smoke-free health care facilities, schools, workplaces, and
government agencies. In late 2013, the General Office of the Chinese Communist Party’s Central
Committee and the General Office of the State Council jointly issued the Notice to the Leaders
and Cadres to Take the Lead on Refraining from Smoking in Public Places (Bureau (2013) 19),
demonstrating the central government’s determination to implement the WHO FCTC and protect
the health of the public. Fifteen cities have passed municipal-level tobacco control regulations
that are close to the requirements of the WHO FCTC’s Article 8. The National Regulation on
Banning Smoking in Public Places is currently being drafted. In addition, there have been multiple
capacity-building training sessions for tobacco control, and national tobacco surveys have been
conducted, including the Global Adult Tobacco Survey and the Global Youth Tobacco Survey.
Since 2014, the central government has started providing funds to pilot programs that offer
cessation services. With efforts on multiple fronts, we have gradually created a social atmosphere
against smoking, built a capable tobacco control workforce, and are making progress in reaching
full compliance with the WHO FCTC.
However, we are alert to the fact that there are more than 300 million smokers in China, with the
smoking prevalence being as high as 52.9% among males age 15 years and above, and that
more than 740 million adults are exposed to secondhand smoke. In addition, the majority of the
public lacks the knowledge of dangers caused by tobacco use, and misconceptions regarding
smoking are pervasive. We still have a long way to go to fulfill our commitment to the WHO FCTC.
The current tobacco survey, conducted jointly by Chinese Center for Disease Control
and Prevention and U.S. Centers for Disease Control and Prevention in 14 cities is vital in
understanding the tobacco epidemic and tobacco control measures in these cities; it provides
rigorous data to evaluate the tobacco control efforts and to support the passage of tobacco
control regulations.
Chinese National Health and Family Planning Commission
March, 2015
vii
Foreword II
In 2015, China is on the cusp of a major breakthrough on tobacco control. As this important
report goes to print, national regulations to make all indoor and many outdoor public places
100 percent smoke-free are before the nation’s lawmakers. Adoption of these regulations would
represent a giant step forward for tobacco control in China – a step which is desperately needed
to curb the devastating impact tobacco has on China’s health, economy and society currently.
For years, many cities around China have been leading the way on pursuing the measures
contained in the WHO Framework Convention on Tobacco Control (WHO FCTC) – implementing
smoke-free and other tobacco control policies in an effort to reduce the terrible impact of tobacco
use on the health of their communities.
In collecting and analyzing systematic data across 14 cities, the China City Adult Tobacco Survey
(CCATS) shines a light on these city-level tobacco control efforts: both on where they have been
successful, as well as on where more work is needed – for instance, in strong enforcement of
smoke-free policies – to ensure that China’s people are effectively protected from the dreadful
health harms of tobacco use and exposure to secondhand smoke.
Encouragingly, the data presented in this report show strong support from the public for tobacco
control: for example, the vast majority of adults in the cities surveyed support banning smoking in
indoor public places, including workplaces and restaurants.
This report comes at a crucial time in China’s tobacco control journey, as the impact of the
city-level efforts documented here can serve as important markers for policies currently being
considered at national level.
On behalf of WHO, I sincerely congratulate Chinese Center for Disease Control and Prevention on
the completion of the CCATS. There can be few more important issues for China than protecting
the health and wellbeing of its people through enacting stronger tobacco control policies. The
results of this important survey will help China to do just that.
Dr Bernhard Schwartländer
WHO Representative in China
March 17, 2015
ix
Preface
The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) took
effect in China on January 9, 2006. The Chinese government has since increasingly recognized
the great impact that curbing the tobacco epidemic could have on preventing and controlling
tobacco-related diseases and deaths, and has been proactively working towards fulfilling its
commitment to the WHO FCTC. Cities are at the forefront of tobacco control efforts in China.
Tobacco control regulations have been passed in 15 cities; many more cities are exploring smokefree environments and anti-tobacco mass-media campaigns in various forms.
It is important to monitor and track the tobacco epidemic. An effective local surveillance system
provides valuable data to understand the magnitude of the tobacco epidemic and evaluate the
impact of local tobacco control interventions. The data can offer scientific evidence not only for
local tobacco control policy changes but also for the establishment and implementation of future
national tobacco control laws and policies.
Systematic tobacco control data are not available in the vast majority of the cities in China. Cities
lacked the capacity and resources to systematically monitor and track the tobacco epidemic on
their own. In response to this need, in 2013, CDC Foundation, the International Union against
Tuberculosis and Lung Disease, and Emory University funded Chinese Center for Disease Control
and Prevention (China CDC) to conduct the adult tobacco survey in Anshan, Changchun, Haerbin,
Hangzhou, Kelamayi, Lanzhou, Luoyang, Nanchang, Qingdao, Shenyang, Shenzhen, Tangshan,
and Tianjin. In addition, Beijing volunteered in joining the survey and provided full funds. China
CDC, WHO, and U.S. Centers for Disease Control and Prevention co-developed the survey
protocol and provided technical support, with the aim of obtaining comparable data through citylevel representative samples, and improving the surveillance capacity to build a solid surveillance
platform in local cities.
The release of this report concludes the work of China City Adult Tobacco Survey 2013–14,
conducted over a span of two years. We hope this report provides a road map for systematic
tobacco surveillance in other cities and regions to advance the tobacco control efforts nationwide.
Chinese Center for Disease Control and Prevention
March 25, 2015
xi
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
China City Adult Tobacco Survey (CCATS) 2013–14 Collaborative Group
Chinese Center for Disease Control and Prevention
(China CDC)
Xiaofeng Liang, Yuan Jiang, Yan Yang, Jijiang Wang,
Yi Nan, Yan Shen, Lili Wang, Mengwu Tu,
Tingting Zhang, Xinyue Chen
Shenzhen
Xiaoli Liu, Yingzhou Yang, Jingfang Xiong, Wei Xie,
Jianjun Su, Ke Xiao, Jie Yang, Jinyao Xie,
Jun Zheng, Haisong Fan
U.S. Centers for Disease Control and Prevention
Luhua Zhao, Yang Song, Jeremy Morton,
Krishna M. Palipudi, Samira Asma
Tangshan
Xuelu Kang, Jing Liu, Chunhui Yu, Jimin Zheng,
Juan Hong, Haiying Hao, Lei Zhang, Shaonan Cui,
Fengzhi Yao, Na Jiang
Beijing
Zejun Liu, Yingsheng Rao, Ying Deng, Xiaopeng Zeng,
Xiurong Liu, Yuqing Li, Yunliang Qian, Yuan Cao,
Mei Han, Guofeng Wan, Yan Chen, Tong Yu
Anshan
Meirong Yu, Fang Wang, Xiwen Deng, Yi Zhang,
Miao Tang, Xiuke Luo, Chengwei Qi, Tianqing Chu,
Yang Hou, Wenhong Zhou
Tianjin
Guohong Jiang, Wenlong Zheng, Wei Li, Yi Yang,
Zhongliang Xu, Wenda Shen, Xiaodan Xue,
Lu Liu, Zibing Wang
Luoyang
Wei Ma, Yujie Sun, Yan Wang, Xiaojun Yang,
Xiujie Liu, Huiling Guo, Ping Zhang, Zhe Wang,
Guiting He, Shengli Li
Shenyang
Yu Song, Lizhu Jiang, Miao Zhang, Han Li, Yang Shi,
Dong Gao, Shu Zhou, Jingchun Tang, Zhiyuan Cao
Kelamayi
Yong Wang, Yuansheng Chen, Yongbing Wang,
Meiling Yuan, Dan Li, Zhen Wang, Suhe Wu,
Yu Bai, Xuefeng Zheng, Ayideng
Changchun
Zhaorui Xu, Yingjian Nie, Jing Ding, Xiaorui Wang,
Ping Zhao, Ying Jiao, Chunyu Zhang
1
CDC Foundation
Brandon Talley, Rachna Chandora, William Parra
Haerbin
Li Zhang, Jian Wang, Jingdong Zhang, Ting Liu,
Zhijie Ma, Xue Jia, Yan Zhang, Chunyan Kang,
Jingjing Lian, Junxue Zhao
Introduction
World Health Organization
Angela Pratt
Emory University
Yixin Duan, Jeffrey P. Koplan
Hangzhou
Chengjian Cao, Jintao Li, Xiaoyan He, Wenhui Zhang,
Qiong Zhang, Feng Yu, Xiaofeng Liu
The International Union Against Tuberculosis
and Lung Disease
Quan Gan, Ehsan Latif
Nanchang
Haiying Chen, Xiaowu Feng, Yibing Fan, Ling Chen,
Zifen Li, Yun Liu, Jun Ling, Xiaolin Zhu, Pingping Zhao,
Huiling Shu, Qingshan Liu, Ying Chen, Yumei Wu
Georgia State University
Pamela Redmon, Michael Eriksen
Lanzhou
Yuhong Wang, Zhaoxin Di, Liping Wan, Xiaowei Qiao,
Minqin Ruan, Fang Yang, Leyu Niu, Jing Lu, Xiaomei Luo
T
obacco use is one of the major risk factors for preventable diseases
and premature deaths. Numerous research has demonstrated that
smoking can cause damage to almost all organs of the human body
(MOH PRC, 2012; USDHHS, 2014), including the top three diseases
causing death in China: cardiovascular diseases, tumors, and chronic
respiratory diseases.
To curb the tobacco epidemic and the harms caused by tobacco use,
the Member States of the World Health Organization (WHO) adopted the
WHO Framework Convention on Tobacco Control (WHO FCTC) (WHO,
2003). The evidence-based MPOWER measures were later introduced by
WHO to assist Member States in implementing the WHO FCTC articles to
reduce demand for tobacco.
Qingdao
Shutao Pang, Shanpeng Li, Fei Qi, Xiaorong Jia,
Yu Meng, Weilin Cao, Wei Hou, Sheyu Lu, Pingping Liu,
Suying Luan, Caiyun Wang, Lingling Huo, Qimin Yang,
Yuqi Li, Bingjun Duan
xii
1
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
active tobacco control programs, used the Tobacco
Questions for Surveys (TQS) to pioneer the China City
Adult Tobacco Survey (GATSCG, 2011). Experiences
and lessons from this project will serve as guidance for
implementing the survey in other cities.
China is the largest tobacco producer and consumer in
the world. Findings from the 2010 Global Adult Tobacco
Survey (GATS) in China showed that there are more than
300 million adult smokers (age 15 years and above);
smoking prevalence among adult males was 52.9% and
2.4% among adult females (Yang, 2011).
The TQS, a
component of the
Global Tobacco
Surveillance
System (GTSS), is
a standard set of
22 key questions.
It can either be
incorporated into
existing surveys, or
used as a standalone survey.
Research on the health burden caused by tobacco
use over the years indicated that deaths attributable
to tobacco use in China increased from an estimated
700,000 in 1990 to 1.4 million in 2010 (Yang, 2013).
By the middle of this century, this burden will peak at
3 million a year, posing an enormous challenge to the
entire health care system in China (Liu, 1998).
In addition, tobacco use places a great financial burden
on Chinese society. It is estimated that in 2008 the total
cost attributable to tobacco use was US$28.9 billion,
a four-fold increase from 2000, including health care
expenditure and the cost of premature death and lost
productivity (Eriksen, 2012).
METHODOLOGY
[
The survey was developed using the standard TQS, with
additional questions that included those regarding
smoke-free policies in the cities, and awareness of these
policies. It consisted of nine sections, as shown below.
CCATS 2013–14 Questionnaire Modules
GTSS
GLOBAL TOBACCO SURVEILLANCE SYSTEM
Tobacco Questions for Surveys
A Subset of Key Questions from the Global Adult Tobacco Survey (GATS)
2nd Edition
The 14 cities participating in this study are: Anshan,
Beijing, Changchun, Haerbin, Hangzhou, Kelamayi,
Lanzhou, Luoyang, Nanchang, Qingdao, Shenyang,
Shenzhen, Tangshan, and Tianjin. Before the data
collection started, Anshan, Haerbin, Hangzhou,
Kelamayi, Qingdao, Shenzhen, and Tianjin already had
local tobacco control regulations in place for public
places. Beijing, Changchun, Lanzhou, and Tangshan
have implemented or established local tobacco control
regulations since then. See Appendix III for details of local
tobacco control regulations for public places in 14 cities.
Effective tobacco control programs, required by the WHO
FCTC, are crucial for curbing the tobacco epidemic,
and a systematic surveillance mechanism to monitor the
epidemic should be an indispensable component of such
programs.
China City Adult Tobacco Survey (CCATS)
Cities are the hubs of economic and social development
in a country. Tobacco control efforts in cities can
influence surrounding areas and serve as examples for
national measures (Redmon, 2014). Since the WHO
FCTC entered into force in China in 2006, many cities
such as Beijing have been leading the nation’s tobacco
control efforts by proactively developing and promoting
local tobacco control regulations and interventions.
To advance local tobacco control efforts, a city-based
tobacco surveillance and evaluation system is critical
to providing extensive data support. With the help of
multiple international organizations, Chinese Center
for Disease Control and Prevention (China CDC),
in collaboration with U.S. Centers for
Disease Control and Prevention
(U.S. CDC), WHO, and 14 cities with
SURVEY OBJECTIVES
The objectives of the survey were:
• To systematically monitor the tobacco epidemic and
track key indicators of tobacco control among adults
in 14 cities.
• To evaluate the implementation of key policies
recommended by the WHO FCTC – and outlined in
the MPOWER package.
Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion,
and sponsorship
Raise taxes on tobacco
2
The target population of the survey was non-institutionalized adult residents in the urban areas of the participating
cities, regardless of their nationality and household registration status. Adults in the survey refer to individuals age
15 or above. The survey did not include those who were
visiting (e.g., tourists), or those who were institutionalized
in hospitals, assisted-living facilities/nursing homes,
college dorms, or military bases. Details of the coverage
of urban areas for each city can be found in Appendix II.
Questionnaire
•
•
•
•
•
•
•
•
•
In 2008 the total cost attributable to tobacco
use was US$28.9 billion, a four-fold increase
from 2000
Target Population
Background characteristics
Tobacco smoking
Smokeless tobacco
Electronic cigarettes (e-cigarettes)
Cessation
Secondhand smoke
Tobacco economics
Tobacco advertising, promotion,
and anti-tobacco messages
Knowledge, attitudes, and perceptions
Sample Design
The survey sample design followed the principles outlined
in the GATS Sample Design Manual, using a multi-stage
cluster sample design (GATSG, 2010). The ju-wei-hui,
the geographically defined neighborhood by which urban
Chinese residents are grouped, was used as the primary
sampling unit (PSU). A typical ju-wei-hui encompasses
1,000 to 2,000 households. The sampling process is
illustrated below. There may be variations between cites
in sample design. It is worth noting that Beijing sampled
48 ju-wei-hui, 23 more than the standard 25 for other
cities.
Although the survey was expanded to the rural areas in
Beijing and Qingdao, all data described in this report are
for urban areas unless specified otherwise.
CCATS 2013–14 Sampling Process
Stage 1
25 PSUs were selected using PPS method, with the number of
households being the measurement of size.
Large PSUs were divided into SSUs of about 750 households,
with one SSU randomly selected.
Step 2
Mapping and listing were conducted to create the household
sampling frame in each PSU/SSU selected.
100 households were selected using simple random sampling.
Step 3
One eligible adult was randomly selected from each participating
household. The eligibility of the adults was determined through a
household questionnaire.
PSU: Primary sampling unit.
SSU: Secondary sampling unit.
PPS: Probability proportional to size.
3
INTRODUCTION
Tobacco Burden in China
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
A target sample size of 2,000 respondents was required
for each city. The adjusted sample size was 2,500 after
taking into account the potential loss due to ineligibility
and non-response (assuming an 80.0% final response
rate). In Beijing, the adjusted sample size was 4,800
in the urban areas. The total target sample size after
adjustment was 37,300 for all 14 cities, with 31,151
respondents completing the survey. The final survey
response rate in each city was calculated by multiplying
three different response rates from each of the three
sampling stages: PSUs, households, and individuals. The
final response rate in Anshan was the highest at 97.5%,
and Kelamayi the lowest at 79.8%. For more information
on the response-rate calculation, please refer to the
GATS Sample Design Manual.
used for data collection; and data were transmitted to
China CDC weekly for data aggregation, cleaning, and
quality check.
Data Collection
Statistical Notes
The 14 cities collected survey data individually between
November 2013 and August 2014. In most cities, one
project coordinator and 4 to 5 field supervisors were
appointed, and one field interviewer was assigned to
each participating PSU. The Tobacco Control Office at
China CDC was responsible for training interviewers and
supervisors in all cities, as well as coordinating all field
work and quality assurance. Handheld computers were
SPSS was used for data cleaning and data management;
SAS-callable SUDAAN was used in data analysis to
obtain point estimates and standard errors accounting
for the survey’s complex sample design features. For
each respondent, weights were calculated, adjusting
for non-responses at each sampling stage, following
the weighting procedure outlined in the GATS Sample
Weights Manual (GATS, 2010). To obtain the final sample
weights, post-stratification was conducted to the total
urban adult population of each city respectively, by
gender and age groups, using population counts from
the 2010 China National Population Census. The results
contained in this report can be used to make inferences
for the urban population in each city. The estimates are
presented across the 14 cities without implications of
statistical significance.
2,135
THE 14 CITIES SURVEYED
Population size (age 15 and above),
number of interviews completed,
and response rate
CCATS 2013–14
Tangshan
number of interviews completed
%
response rate
Haerbin 82.0%
85.7%
Tianjin
2,213
0.3m
An interviewer conducting the survey.
85.9%
Beijing
92.2%
Changchun
3,838
1,970
Kelamayi
1,966
1,977
urban population (m: million)
00
80.2%
INTRODUCTION
Sample Size
3.3m
1,957
2.2m
79.8%
81.4%
Shenyang
3.4m
1.7m
0.9m
14.3m
4.1m
2.0m
2,346
97.5%
Anshan
4.8m
0.9m
2,041
Qingdao
4.5m
2.0m
2,029
2,166
Lanzhou
Hangzhou
8.6m
90.6%
85.9%
2,282
2,188
Luoyang
84.7%
Nanchang
96.2%
91.4%
2,043
Shenzhen
4
89.0%
5
2
Tobacco Smoking and
E-Cigarette Use
I
n China, smoking is the main form of tobacco use, which
includes products such as manufactured cigarettes, cigars,
pipes, and waterpipes (Yang, 2011). Hence, this report focused
on smoking behaviors among adults in the 14 cities. The use of
e-cigarettes was also investigated due to its rapid rise in many countries
in recent years (WHO, 2014).
7
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Cigarettes Smoked per Day
E-Cigarettes
The current tobacco smoking prevalence (including daily
and less than daily) in the 14 cities ranged from 17.7% in
Qingdao to 24.5% in Shenyang. With the exceptions of
Haerbin, Qingdao, and Shenzhen, it was above 20.0% in
all cities. Among men, the cities with the highest smoking
prevalence were Shenyang (44.8%), Luoyang (44.1%),
and Anshan (44.0%), while the lowest was in Qingdao
at 32.7%. Women’s smoking prevalences were far lower
than men’s in all cities, ranging from 0.4% in Kelamayi to
5.0% in Shenyang, with the relatively higher prevalences
found in cities from the north and northeastern regions.
The average number of cigarettes smoked per day
among daily smokers in each of the 14 cities exceeded
13.0 cigarettes, with the highest in Qingdao at 15.9, and
the lowest in Lanzhou at 13.2. Heavy smokers (those
who smoke 20 or more cigarettes per day) made up a
large percentage of the current daily smokers, ranging
from 49.3% in Qingdao to 32.0% in Lanzhou.
E-cigarettes have become increasingly popular in China
and many other countries worldwide in recent years. In
the current survey, more than 40.0% of adults reported
having heard of e-cigarettes in each of the 14 cities.
[
Women’s smoking rates were far lower than
men’s in all cities
Percentage of adults
age 15 and above
CCATS 2013–14
Luoyang
62.7%
heard of e-cigarettes
0.3%
currently use e-cigarettes
However, in all 14 cities, the percentage of adults who
currently used e-cigarettes was low, with the highest
found in Luoyang at 1.7%. The survey shows that the
majority of current e-cigarette users were also current
cigarette smokers (80.0% or more in all cities). Some
e-cigarette users reported that they were not current
tobacco smokers, including adults who had never
smoked tobacco before.
54.3%
Nanchang
0.8%
Changchun
53.9%
0.6%
[
The majority of e-cigarette users were
cigarette smokers
The proportion of daily smokers among current smokers
was high in all cities. With the exception of Shenzhen
(64.5%), all cities had proportions higher than 75.0%;
the highest was in Tianjin and Changchun (both above
90.0%).
AWARENESS AND USE OF
E-CIGARETTES
1.7%
Shenzhen
51.5%
0.7%
Tangshan
48.0%
0.9%
Lanzhou
47.1%
0.8%
CURRENT TOBACCO SMOKING PREVALENCE
Percentage of adults
age 15 and above
CCATS 2013–14
current daily
total
Shenyang
46.9%
female
0.4%
male
Tianjin
17.7%
Qingdao
0.9%
18.6%
Shenzhen
0.7%
18.8%
Haerbin
20.5%
Kelamayi
Tangshan
1.9%
22.0%
Lanzhou
1.8%
22.1%
Tianjin
22.3%
Beijing
2.1%
22.5%
Nanchang
1.9%
23.0%
Luoyang
23.4%
Anshan
23.5%
Changchun
24.5%
Shenyang
44.8%
38.6%
0.4%
21.3%
Beijing
35.1%
1.5%
Hangzhou
1.3%
33.9%
2.7%
21.3%
45.0%
32.7%
41.6%
0.4%
Hangzhou
40.6%
41.2%
3.3%
44.0%
41.1%
1.3%
41.5%
42.2%
44.1%
1.0%
2.8%
Haerbin
43.9%
0.5%
44.0%
43.2%
3.8%
5.0%
43.6%
44.8%
0.7%
All 14 cities showed a similar pattern regarding current
smoking prevalence in different age groups. The smoking
prevalence among those age 15–24 years was relatively
low, was highest for those in the 45–64 age groups, and
then decreased after age 65.
42.5%
0.1%
Qingdao
41.3%
8
9
Kelamayi
Anshan
TOBACCO SMOKING AND E-CIGARETTE USE
Current Tobacco Smoking
3
Cessation
Q
uitting smoking has rapid effects in reducing harm to lung and cardiovascular
function (USDHHS, 2010). Evidence suggests that smoking cessation can
significantly lower smokers’ risk of developing many diseases, including malignant
tumors such as lung cancer and laryngeal cancer, as well as common chronic
diseases such as coronary heart disease, stroke, and chronic obstructive pulmonary
disease. Cessation improves the prognosis for those who have developed these
diseases, and reduces the risk of premature death (Jha, 2014; MOH PRC, 2012).
Encouraging smokers to quit through brief cessation advice by health care providers
(HCP) is a cost-effective public health intervention (MOH PRC, 2012).
This section describes smoking cessation in the 14 cities in terms of quit ratio, quit
attempt, intention to quit among current smokers, and receiving advice to quit from
HCPs.
11
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
quitting. The highest percentage of those having intention
to quit was in Shenzhen at 22.0%, and the lowest in
Anshan at 7.9%.
The quit ratio, defined as the percentage of former daily
tobacco smokers among ever daily tobacco smokers,
is an important indicator, reflecting the efficacy of the
tobacco control efforts in a region.
Quit Attempts
The percentage of current tobacco smokers who tried to
quit smoking in the past 12 months was below 40.0%
in all cities. The highest was found in Shenzhen (39.7%),
followed by Kelamayi (39.6%); it was lowest in Tianjin
(16.4%), followed by Anshan (17.6%). The percentage
of those who tried at least once to quit for 24 hours or
longer in the past 12 months, ranged from 30.0% in
Shenzhen to 10.7% in Tianjin.
The quit ratio was lower than 20.0% in all 14 cities, with
five cities (Beijing, Changchun, Haerbin, Lanzhou, and
Tangshan) having ratios below 10.0%.
Intention to Quit
Current tobacco smokers in the 14 cities showed little
interest in quitting smoking in the next 12 months.
Across all cities, most tobacco smokers did not consider
Advice from Health Professionals
Advice from health care providers (HCP) plays an
important role in aiding smokers to quit. Evidence
suggests that HCPs’ advice, even brief cessation advice,
can significantly increase the percentage of tobacco
smokers attempting to quit, as well as the actual quit rate
among smokers (Stead, 2013). Among current tobacco
smokers who visited an HCP in the past 12 months, the
percentage of those who received advice to quit smoking
from the HCP varied greatly in the 14 cities. The highest
was in Shenyang (70.2%) and Qingdao (70.1%), and the
lowest was in Hangzhou (41.8%) and Kelamayi (46.4%).
CESSATION
Quit Ratio
[
Even brief cessation advice can significantly
increase the percentage of smokers attempting
to quit, as well as the actual quit rate
QUIT ASSISTANCE
Percentage of current tobacco smokers age 15 and above
who visited an HCP in the past 12 months and
were given quit advice by the HCP
CCATS 2013 –14
QUITTING TOBACCO SMOKING
70.2%
Percentage of tobacco smokers
age 15 and above
CCATS 2013–14
70.1%
66.5%
61.6%
59.4%
58.2%
58.1%
57.2%
Percentage of former daily tobacco smokers
among ever daily tobacco smokers (quit ratio)
53.9%
51.0%
49.7%
48.6%
46.4%
41.8%
17.1%
Qingdao
16.9%
Kelamayi
15.7%
Luoyang
14.7%
Tianjin
14.2%
Nanchang
13.1%
Shenzhen
12.8%
12.5%
Hangzhou
Shenyang
12.2%
Anshan
9.9%
9.7%
9.6%
Beijing
Lanzhou
Changchun
6.8%
6.8%
Haerbin
Tangshan
Intending to quit
in next 12 months among current tobacco smokers
Shenyang
Qingdao
Tianjin
Tangshan
Lanzhou
Changchun
Beijing
Shenzhen
22.0%
14.2%
Qingdao
13.3%
Kelamayi
13.4%
Luoyang
9.9%
10.2%
Tianjin
Nanchang
13.6%
11.7%
Shenzhen
7.9%
Hangzhou
Shenyang
Anshan
12.3%
13.1%
11.6%
12.1%
10.8%
Beijing
Lanzhou
Changchun
Haerbin
Tangshan
Attempted to quit
among current tobacco smokers in the past 12 months
39.7%
39.6%
25.7%
26.3%
25.4%
24.3%
20.7%
16.4%
Qingdao
Kelamayi
Luoyang
Tianjin
Nanchang
Shenzhen
Hangzhou
Shenyang
12
22.8%
25.9%
24.5%
22.8%
17.6%
Anshan
Beijing
Lanzhou
Changchun
Haerbin
19.6%
Tangshan
A doctor checks a patient.
13
Luoyang
Anshan
Haerbin
Nanchang
Kelamayi
Hangzhou
4
Secondhand Smoke Exposure
T
here is no safe level of secondhand smoke (SHS) exposure. Research indicates
that exposure to SHS can cause lung cancer and also increases the risk of
many other diseases in non-smokers (USDHHS, 2010). The only effective way to
fully protect non-smokers from the harm of SHS is to prohibit smoking completely
in all enclosed spaces (USDHHS, 2006).
This section examines SHS exposure (defined as noticing someone smoking in the
past 30 days in the specific venues) among adults at home, at indoor workplaces,
and on visits to indoor public places, including government buildings/offices, health
care facilities, restaurants, bars/nightclubs, public transportation, universities, and
primary, secondary, and high schools (both indoor and outdoor areas). Adults were
also asked about their attitudes toward prohibiting smoking and their awareness of
existing indoor smoking bans in the city where they were living.
15
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Health Care Facilities
Restaurants, Bars/Nightclubs
The highest prevalence of exposure in the home was
found in Anshan (49.5%) and the lowest in Kelamayi
(27.1%).
Among the 14 cities, only one city had an SHS exposure
prevalence in health care facilities that was over 40.0%
(Nanchang, 43.9%). The lowest percentage was found in
Kelamayi at 7.3%.
Our findings show that among all types of indoor public
places surveyed, the SHS exposure prevalence was
highest in bars/nightclubs across all cities. It was over
90.0% in half of the cities, with the lowest percentage
still as high as 69.1% in Qingdao. The next highest SHS
exposure prevalence was in restaurants, which ranged
from 80.8% in Tianjin to 42.4% in Shenzhen. In half of
the cities, this exposure prevalence surpassed 70.0%.
Workplaces
Public Transportation
With the exception of Beijing, Kelamayi, and Qingdao,
the SHS exposure prevalence in indoor workplaces was
higher than 40.0% across the cities, with the highest in
Nanchang (59.6%). For the remaining three cities, the
prevalence was 26.2% in Qingdao, 36.3% in Kelamayi
and 36.4% in Beijing.
Among all public places examined in the study, public
transportation had the lowest SHS exposure prevalence
across all cities, with Nanchang having the highest
percentage at 19.0%, and Beijing the lowest at 3.1%.
Schools
Government Buildings/Offices
Exposure to SHS at primary, secondary, and high
schools, including technical schools (both indoor and
outdoor), was above 20.0% in all cities, with the highest
prevalence of 45.0% in Nanchang. For the indoor areas
in universities, the prevalence ranged from 32.5% in
Nanchang to 13.8% in Tangshan.
The SHS exposure prevalence in government buildings/
offices was highest in Nanchang (44.0%), and lowest
in Kelamayi (9.3%), with most cities having exposure
percentages higher than 20.0%.
SHS EXPOSURE IN PUBLIC PLACES
[
Percentage of adults age 15 and above
who were exposed to smoke in
indoor public places*
in the past 30 days
CCATS 2013 –14
Exposure to SHS at primary, secondary,
and high schools, including technical
schools, was above 20.0% in all cities
A young girl disseminates anti-smoking flyers.
Support for Smoking Ban
Almost all adults supported prohibiting smoking
completely inside health care facilities, workplaces,
indoor areas of universities, primary, secondary, and
high schools, including technical schools, and taxis,
with prevalences being over 90.0% in all cities except
for workplaces (88.1%) and taxis (86.2%) in Shenyang.
Support for prohibiting smoking in restaurants was also
very high across all the cities, with the majority of cities
showing more than 80.0%.
The support for prohibiting smoking in bars/nightclubs
was lower, ranging from 29.0% in Lanzhou to 67.9% in
Nanchang.
SUPPORT FOR SMOKING BANS
Percentage of adults age 15 and above
who supported complete smoking bans
in restaurants and bars/nightclubs
CCATS 2013–14
workplaces
primary, secondary, and high schools
health care facilities
public transportation
*: Outdoor areas were included for schools.
60%
restaurants
bars/nightclubs
90%
80%
70%
50%
60%
40%
50%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Nanchang
Luoyang
Shenyang Changchun Hangzhou Tangshan
Lanzhou
16
Tianjin
Anshan
Haerbin
Shenzhen
Beijing
Kelamayi
Qingdao
Nanchang Shenzhen
Beijing
Hangzhou Kelamayi
Anshan
Tianjin
17
Haerbin
Qingdao
Luoyang
Tangshan Changchun Lanzhou
Shenyang
SECONDHAND SMOKE EXPOSURE
Homes
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Awareness of Smoking Bans
Qingdao also prohibited smoking in bars/nightclubs,
but the level of awareness was only 24.0% in Qingdao,
19.5% in Anshan, and 13.5% in Kelamayi.
Participants from each of the 14 cities were asked
whether they were aware of any regulations prohibiting
smoking in indoor public places in the city where they
were living. Although the National Health and Family
Planning Commission and the Ministry of Education
require that all indoor areas of hospitals and all areas
(indoor and outdoor) in primary, secondary, and high
schools, including technical schools, be smoke free, the
percentage of adults who were aware of these smoking
bans for indoor places was not very high. The lowest
levels of awareness for such regulations in health care
facilities and schools were 34.1% and 35.2% respectively
(both found in Nanchang), and the highest were 69.7%
and 77.9% respectively (both found in Haerbin).
48.0%
52.7%
Shenzhen
Haerbin
Qingdao
28.2%
AWARENESS OF SMOKING BANS
Percentage of adults age 15 and above
aware of complete smoking bans in
restaurants
CCATS 2013 –14
Prior to the survey, Anshan, Haerbin, Kelamayi, Qingdao,
and Shenzhen had tobacco control regulations in place
that prohibited smoking completely in restaurants, but
awareness of this regulation was below 50.0% in all of
these cities except Haerbin. Tobacco control
regulations in Anshan, Kelamayi, and
% 100
Kelamayi
26.0%
Anshan
% 100
90
80
80
70
70
60
60
50
50
40
40
% 100
30
30
90
20
20
80
10
10
70
0
0
Beijing
80
70
80
70
60
70
60
50
60
40
30
40
30
20
30
20
10
20
0
10
10
Haerbin
0
Changchun
Tangshan
% 100
Tianjin
Tobacco Marketing and
Anti-Tobacco Messages
90
50
80
40
70
30
60
20
50
10
0
5
50
40
50
0
90
80
90
% 100
% 100
90
% 100
90
60
35.4%
40
30
Kelamayi
20
10
0
% 100
Shenyang
90
80
90
60
80
50
40
% 100
30
90
20
80
10
70
0
60
Lanzhou
50
80
40
70
30
60
50
20
50
10
40
30
0
30
20
20
10
0
60
90
40
AWARENESS OF INDOOR
SMOKING BANS
70
% 100
0
Luoyang
Percentage of adults age 15 and above
aware of complete smoking bans for
indoor areas in health care facilities
and schools*
CCATS 2013–14
health care facilities
schools
*: primary, secondary, and high schools, including technical schools.
90
Shenzhen
80
% 100
70
90
90
60
80
80
50
70
70
40
60
60
30
50
50
20
40
40
10
30
30
0
20
20
10
10
% 100
0
Nanchang
18
Anshan
% 100
10
0
T
obacco advertising, promotion, and sponsorship (TAPS) can attract
new tobacco users, increase current smokers’ consumption, weaken
a smoker’s intention to quit, and cause quitters to relapse. Research
demonstrated that prohibiting all forms of TAPS reduces tobacco use and is
a cost-effective tobacco control measure (NCI, 2008).
% 100
70
The present survey investigated the exposure to seven forms of TAPS
activities among adults in the past 30 days, as well as the penetration rate of
local tobacco control campaigns.
Qingdao
Hangzhou
19
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Anti-Cigarette Messages
Cigarette advertising in a local tobacco shop.
The seven forms of TAPS activities described in this
section are: cigarette advertising at the point of sale
(POS), free cigarette samples, sales prices, coupons,
free gifts/discounts on other products, clothing/item with
brand name or logo, and promotion of cigarettes through
the mail.
Cigarette advertising at POS was the most prevalent
among the seven forms, with the highest percentage of
exposure found in Haerbin (14.1%) and lowest in Anshan
(7.6%). The percentage of adults who noticed each of the
further six TAPS activities was mostly lower than 2.0%,
except for free gifts or discounts on other products.
In recent years, all 14 cities have conducted various
forms of anti-cigarette media campaigns. The survey
asked participants whether they had been aware in
the past 30 days of any information in newspapers/
magazines or on the television (TV) explaining the
dangers of smoking cigarettes or encouraging quitting.
More than half of adults in each of the cities reported
seeing anti-cigarette information either in newspapers/
magazines or on TV in the past 30 days, ranging from
75.5% in Kelamayi to 58.1% in Changchun. Across all
cities, the percentage of adults who reported seeing
anti-cigarette information on TV was higher than for
newspapers/magazines.
[
Health warning labels on cigarette packs (actual brand
names and logos removed).
A relatively high percentage of adults
reported seeing cigarette advertising
at the point of sale, ranging from
7.6% to 14.1%
[
ANTI-CIGARETTE MESSAGES IN THE MEDIA
Percentage of adults age 15 and above
who noticed anti-cigarette messages
in the past 30 days
CCATS 2013–14
All 14 cities have recently conducted
anti-cigarette media campaigns
on television
CIGARETTE MARKETING
Percentage of adults age 15 and above
who noticed cigarette marketing
in the past 30 days
CCATS 2013 –14
advertising at the point of sale
free gifts/discounts on other products
in newspapers/magazines
80%
70%
18%
60%
15%
50%
12%
40%
9%
30%
6%
20%
3%
10%
0%
0%
Haerbin
Shenyang
Qingdao
Beijing
Changchun Hangzhou Nanchang Shenzhen
20
Lanzhou
Tianjin
Luoyang
Kelamayi
Tangshan
Anshan
Kelamayi
Tangshan
Luoyang
Lanzhou
Shenzhen
Anshan
Haerbin
21
Tianjin
Beijing
Qingdao
Nanchang Shenyang Hangzhou Changchun
TOBACCO MARKETING AND ANTI-TOBACCO MESSAGES
Tobacco Marketing
6
Knowledge, Attitudes,
and Perceptions
I
n order to encourage smokers to quit, and to discourage non-smokers from
starting, it is important to make people aware of the harmful effects smoking
can have on their health.
This section describes adults’ knowledge of the harmful effects of tobacco use
in the 14 cities, including whether they were aware that smoking or exposure to
secondhand smoke (SHS) can cause specific diseases, and their perception of
the harmful effect of low-tar cigarettes.
23
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
was lower, and the percentage who knew that smoking
can cause erectile dysfunction was the lowest. The city
with the lowest awareness that smoking can cause
stroke and heart attack was Lanzhou (32.4% and 43.5%,
respectively), and the city with the highest percentages
was Tianjin (66.1% and 74.9%, respectively).
This survey measured adults’ knowledge of the health
risks associated with cigarette smoking, specifically: lung
cancer, stroke, heart attack, and erectile dysfunction. The
results show that adults in the 14 cities were most aware
that smoking can cause lung cancer. With the exception
of Kelamayi and Lanzhou, over 90.0% of adults in all
cities had this knowledge.
The percentage of adults who were aware that smoking
can cause erectile dysfunction was only between 20.0%
and 40.0%, with the highest found in Shenzhen (39.4%).
Compared with lung cancer, the percentage of those who
knew that smoking can cause stroke and heart attack
[
In all 14 cities, adults were least aware that
smoking can cause erectile dysfunction
Knowledge of Harms Caused by SHS
Tangshan. Across all cities, the percentage of those
who knew SHS can cause heart disease in adults was
the lowest, ranging from 49.9% in Lanzhou to 74.3% in
Tianjin.
This survey also investigated the extent of the knowledge
possessed by adults in the 14 cities regarding SHS
causing lung cancer and heart disease in adults, and lung
disease in children.
Overall, adults in Tangshan and Tianjin had the highest
awareness that SHS can cause all three diseases, with a
percentage of 70.5% and 70.4% respectively; the lowest
percentage was in Lanzhou (46.9%).
Of the three diseases, the highest percentage was
for those who knew that SHS can cause lung cancer,
reaching 80.0% and above in all 14 cities, with Lanzhou
having the lowest percentage at 82.1% and Tangshan
the highest at 92.7%. The percentage of those who knew
that SHS can cause lung diseases in children trailed
behind, ranging from 74.8% in Shenyang to 87.2% in
The difference in the awareness of the harms caused
by SHS is also noticeable between smokers and nonsmokers. In most cities, smokers were less aware of the
harms of SHS than non-smokers.
[
KNOWLEDGE OF TOBACCO HARMS
Across all 14 cities, the percentage of
adults who knew SHS can cause heart
disease in adults was the lowest
Percentage of adults age 15 and above
who held various beliefs regarding the
harms of smoking
CCATS 2013–14
KNOWLEDGE OF SHS HARMS
Percentage of adults age 15 and above
who held various beliefs regarding
the harms of SHS
CCATS 2013–14
smoking can cause lung cancer
smoking can cause heart attack
SHS can cause lung cancer in adults
SHS can cause lung diseases in children
smoking can cause stroke
smoking can cause erectile dysfunction
SHS can cause heart disease in adults
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Tangshan
Tianjin
Luoyang
Beijing
Shenzhen Shenyang Nanchang
24
Qingdao
Hangzhou Changchun Haerbin
Anshan
Kelamayi
Lanzhou
Tangshan
Beijing
Tianjin
Anshan
Haerbin
Qingdao
Luoyang
25
Hangzhou Shenyang Shenzhen Nanchang Changchun Kelamayi
Lanzhou
KNOWLEDGE, ATTITUDES, AND PERCEPTIONS
Knowledge of Harms Caused by Smoking
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Perception of Harms Caused by Low-Tar
Cigarettes
Low-tar cigarettes have been promoted by the tobacco
industry in the West since the 1950s as a healthier
alternative to regular cigarettes. Cigarette manufacturers
in China have recently begun marketing low-tar cigarettes
in an effort to assuage concerns about the negative
health effects of smoking (Yang, 2014). However,
research has shown that using low-tar cigarettes does
not reduce the harm caused by smoking cigarettes
(USDHHS, 2010).
Tar content indicated on a cigarette pack.
EDUCATION AND FALSE BELIEF
Percentage of adults age 15 and above
who falsely believed low-tar cigarettes are less harmful
than regular cigarettes, by education level
CCATS 2013–14
primary school or less
secondary school
high school
college or above
The results of this survey show that many adults falsely
believed that low-tar cigarettes were less harmful than
regular cigarettes. Among the 14 cities, the highest
percentage of respondents with this belief was found in
Nanchang (42.7%) and the lowest in Tianjin (24.8%).
Shenyang
Qingdao
Our findings further suggest that this misperception
about the harms associated with low-tar cigarettes may
vary with adults’ smoking status and level of educational
attainment. A higher percentage of smokers than nonsmokers tended to believe that low-tar cigarettes cause
less harm. Furthermore, the pattern that as education
level increased, the percentage of those with the false
belief also increased, was observed in 9 out of 14 cities.
Anshan
Lanzhou
Nanchang
7
Haerbin
Cigarette Economics
Hangzhou
Kelamayi
[
Changchun
Tianjin
Beijing
Tangshan
Luoyang
Shenzhen
0%
10%
20%
30%
40%
50%
26
Many adults falsely believed that low-tar
cigarettes are less harmful than regular cigarettes
T
he cost of cigarettes can play an important role in reducing smoking
prevalence through preventing initiation and promoting cessation.
In each city, the median cost of 20 manufactured cigarettes (the number
of cigarettes in a typical pack) and the median monthly expenditure on
cigarettes were both estimated. The cost per 20 manufactured cigarettes
was calculated by dividing the amount of money paid by the number
of manufactured cigarettes bought during the last purchase, and then
multiplying by 20. The monthly expenditure was acquired by multiplying
the estimated cost per manufactured cigarette by the estimated number
of manufactured cigarettes smoked per month.
27
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Cigarette Affordability
Monthly Expenditure on Cigarettes
Among current smokers in all 14 cities, the median
cost of 20 manufactured cigarettes was less than
¥10.0, except in Hangzhou (¥19.9), Nanchang (¥12.6),
Shenzhen (¥14.9), Haerbin (¥10.0) and Lanzhou (¥10.0).
The median monthly expenditure on manufactured
cigarettes was more than ¥150.0, except in Kelamayi and
Tianjin. It was highest in Hangzhou at over ¥300.0, with
Nanchang and Shenzhen both over ¥200.0. Kelamayi
had the lowest figure at ¥144.0.
The cost of 2,000 manufactured cigarettes as a
percentage of GDP per capita measures the affordability
of manufactured cigarettes, known as the relative income
price (RIP). A small percentage indicates high affordability
or that the cigarette price is relatively cheap, and vice
versa. The results reveal that the RIP was slightly above
1.0% in most cities, with the highest RIPs in Haerbin
(2.2%), Hangzhou (2.1%), Luoyang (2.1%), Lanzhou
(2.0%) and Nanchang (1.9%).
The monthly expenditure on cigarettes as a percentage
of monthly disposable income per capita is often used to
measure the budget share spent on cigarettes. Using the
median monthly expenditure on manufactured cigarettes,
this ratio was highest in Hangzhou and Nanchang (at
9.2% and 10.0%) and lowest in Beijing and Tianjin (5.2%
and 5.5% respectively).
8
Conclusions and
Recommendations
COST OF MANUFACTURED CIGARETTES
AND RELATIVE INCOME PRICE
An interviewer working in the field.
Among current smokers age 15 and above
CCATS 2013 –14
median cost of 20 manufactured cigarettes
relative income price of manufactured cigarettes (RIP)
¥20.0
4.0%
¥15.0
3.0%
¥10.0
2.0%
¥5.0
1.0%
C
hina is the first country to conduct systematic, subnational tobacco
surveillance in multiple cities using Tobacco Questions for Surveys.
This survey covered the urban areas in 14 cities that have relatively
advanced economies and robust tobacco control programs.
In this section, key survey findings are summarized and compared with
the urban data from the Global Adult Tobacco Survey (GATS) in China, a
nationally representative survey conducted in 2010. This is followed by
some recommendations for future tobacco control work.
0.0%
¥0.0
Hangzhou Shenzhen Nanchang Lanzhou
Haerbin
Luoyang Changchun Qingdao
28
Tangshan
Beijing
Kelamayi Shenyang
Tianjin
Anshan
29
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
The vast majority of smokers in China are male. The
current smoking prevalence among urban males in 14
cities ranged from 32.7% to 44.8%. Although still at
a high level, all were below the 2010 national average
(49.2%). Overall, smoking prevalence among urban
females remained at low levels.
However, opportunities exist to further improve tobacco
control regulations and their enforcement. For example,
in many cities the tobacco control regulations currently
in place do not prohibit smoking in certain indoor public
places such as restaurants, bars, and nightclubs.
SHS exposure was very prevalent in these settings.
Furthermore, many of these smoke-free policies are
poorly enforced. A high percentage of adults were not
aware that local smoke-free policies were in effect. Poor
enforcement of the regulations significantly reduces their
effectiveness, posing a challenge to tobacco control
efforts.
High awareness of e-cigarettes, some use among
current tobacco smokers
In the past few years, there has been a rapid global
increase in the use of e-cigarettes, which have
been promoted by the e-cigarette manufacturers
as an alternative to regular cigarettes (WHO, 2014).
E-cigarettes attained a high degree of awareness in
the 14 participating cities, while a small percentage of
adults reported using the products. It is worth noting that
current e-cigarette users consisted of current tobacco
smokers and adults who were not current tobacco
smokers, some of whom had never smoked tobacco
before. The evidence on the health consequences of
using e-cigarettes is still inconclusive. With strengthened
tobacco control efforts, particularly the implementation
of smoke-free policies in public places, it is possible that
more smokers, and potentially some non-smokers, may
initiate e-cigarette use in the future.
Quit rate low, cessation services need strengthening
In many of the 14 cities, fewer than half of smokers
who had visited health care providers (HCPs) in the
past 12 months received advice to quit from the HCPs.
These findings suggest that there is a lack of training or
willingness among HCPs to provide cessation services.
It could also be attributed to cessation services not
being included in basic medical services, and cessation
drugs not being listed in the catalogue of national
basic medicines. China started building the smoking
cessation service in 2006 by establishing quitlines and
cessation clinics, and by training HCPs to offer cessation
interventions. The service could be strengthened in the
future.
Smoke-free policy in public places taking roots, but
secondhand smoke (SHS) exposure still a challenge
The results of the 14 cities indicate that SHS exposure
in public places was lower than the 2010 national
average, due possibly in part to the recent anti-smoking
campaigns and efforts to promote smoke-free
policies.
Knowledge of the harms of tobacco use can be
further improved
Indoor SHS exposure in public
transportation and health care facilities
was lower than in other public places.
This finding is likely to be the result of
the 1997 directive from the National
Commission of Patriotic Sanitation
Campaign, which prohibited smoking in
public transportation, and the guideline
released by the former Ministry of Health
in 2009, which required the indoor areas
of all health care facilities to be smoke-
Knowledge of the harms of smoking
and SHS among adults has improved
across all 14 cities in comparison to
the results from the GATS 2010. The
extensive tobacco control mass-media
campaigns and interventions in recent
years have effectively raised populationlevel awareness of the harms caused
by smoking and SHS. This progress
is reflected in the survey results. Yet,
people’s knowledge of tobacco harms is
far from adequate. About half of the adults did not know
that smoking can cause stroke or heart disease. The
awareness of smoking causing erectile dysfunction was
even lower. In addition, many people falsely believed that
low-tar cigarettes are less harmful than regular cigarettes,
a likely consequence of the tobacco industry’s promotion
of “low tar, low harm”. Moreover, adults with higher
education were more likely to hold this misperception
than the less educated.
Recommendations
Although China ratified the WHO FCTC as early as in
2005, the survey data demonstrate that male adult
smoking prevalence and adult SHS exposure in public
places are still high. The full implementation of WHO
FCTC articles can reduce the harms caused by tobacco
use. Therefore, we propose the following in accordance
with the WHO FCTC and the survey results:
1. Continue to promote comprehensive tobacco
control regulations locally and nationally,
developing a new social norm of smoke-free
public places. As of 2012, 44 countries have passed
comprehensive smoke-free laws for public places,
covering 1.1 billion people worldwide (WCTOH,
2015). There is currently no national smoke-free law in
China and most regions do not have local legislation
conforming to the WHO FCTC articles. Effective
and enforceable tobacco-free policies are critical
in protecting the public from the harms caused by
tobacco smoking. Experiences and lessons from local
legislations and enforcement could help establish the
national tobacco control regulations.
Tobacco advertising and promotion still visible
The survey findings demonstrate that tobacco advertising
and promotion are still present in various forms,
especially cigarette advertising at the point of sale. The
percentage of adults who were exposed to tobacco
advertising would be even higher if we were to consider
the display of tobacco products, which is a hidden
form of tobacco advertising. Tobacco advertising and
promotion glamorizes smoking, thwarting the impact
of bans on other forms of tobacco marketing, and of
tobacco prevention and control efforts in general (NCI,
2008; USDHHS, 2012). Therefore, the prohibition of
tobacco marketing in all forms, direct and indirect, could
be beneficial.
2. Ongoing monitoring and research on e-cigarettes.
The evidence on the health consequences of
e-cigarette use, particularly over the long term,
is still evolving. There is also insufficient evidence
Cigarette prices very low and affordable
The relative income price (RIP), which represents the
cost of purchasing 2,000 manufactured cigarettes as
a percentage of GDP per capita, in all cities was well
below the 2010 national estimate (2.4%). The RIP ranged
from 1.0% to 2.0% in most cities. It is worth noting that
in the RIP calculation we used the city-wide GDP per
capita (including the rural areas, which had lower GDP
per capita) to approximate the urban GDP per capita.
Therefore, the actual urban RIP in the 14 cities is even
lower.
The survey findings demonstrate that the current prices
of manufactured cigarettes in China are low, with
cigarette products becoming more affordable as the
economy grows.
A water cup bearing cigarette
advertisement.
An interviewer conducting the survey.
30
31
CONCLUSIONS AND RECOMMENDATIONS
free. These two regulations were also relatively well
enforced. SHS exposure was relatively lower in cities
with smoke-free regulations when compared to those
without regulations, such as Nanchang, underscoring
the protective effects of the smoke-free policies on nonsmokers.
Current smoking prevalence among males lower than
the national average
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
to conclude whether e-cigarettes help users quit
smoking or not. Additional research is needed on
multiple areas of e-cigarette use. Even while the
evidence base is evolving, stronger regulations
of e-cigarettes and similar devices could address
potential health concerns.
5. Monitor tobacco marketing activities, stop
tobacco advertising, promotion and sponsorship
(TAPS) in all forms. Prohibiting all forms of direct
and indirect tobacco advertising, promotion and
sponsorship is effective in reducing the prevalence
of tobacco use. The new National Advertising Law,
effective September 1, 2015, prohibits tobacco
advertising in the media, in venues such as public
places, public transportation and other outdoor
areas, and towards minors in any form. However, the
tobacco industry is unlikely to spare any efforts in
exploring new ways to promote their products and to
expand their consumer base (WHO, 2013). Therefore,
it is important to monitor the tobacco industry’s
marketing activities in order to stop all forms of TAPS.
3. Sustain effective long-term public-education
campaigns on the dangers of tobacco use,
with the utilization of both traditional and social
media. Mass-media campaigns are an effective way
to warn the public about the dangers of tobacco
use, encourage smokers to quit, and mobilize public
support for tobacco prevention and control. In
response to the lack of knowledge about the harms
of tobacco use among the general public, it would be
beneficial to conduct educational campaigns focusing
on information that people are less aware of.
NORTHEAST
Haerbin
Kelamayi
7. Raise tobacco taxes and prices. Raising tobacco
prices is the single most effective way to reduce
consumption, particularly among the low-income
population. Increasing the prices of tobacco
through taxation can not only discourage people
from smoking, but can also increase government
revenues (WHO, 2014). The survey findings indicate
that cigarette prices are very low in China. Therefore,
opportunities exist to increase cigarette prices by
raising taxes, particularly for non-premium cigarettes,
thus reducing tobacco consumption.
4. Enforce tobacco control policies and best
practices. The effectiveness of tobacco control
regulations depends largely on how well they are
enforced. It is critical that cities monitor and evaluate
the enforcement of these policies and identify best
practices. Through the synergy of effective law
enforcement and public-education campaigns,
the acceptance of smoking could be reduced and
eventually reversed. Cities could help transform the
social norms regarding smoking in the surrounding
areas and eliminate smoking in public places.
32
Shenyang
Anshan
NORTH
Beijing
NORTHWEST
Tangshan
Tianjin
Qingdao
Lanzhou
Luoyang
EAST
Hangzhou
SOUTHWEST
6. Improve the cessation service system. Cessation
services can provide valuable and effective assistance
to smokers in their efforts to quit. To make cessation
services accessible and affordable, the following
measures could be taken: incorporate brief cessation
advice into the routine medical procedures offered by
health care providers; include cessation assistance as
part of the national basic medical services; and enlist
cessation drugs as national basic medicines.
Graphic health warnings on tobacco packages
were shown to be one of the most cost-effective
ways to deliver messages on the harms caused by
tobacco use, and have been adopted by a third of
the countries in the world to date (CCS, 2014). China
could adopt graphic health warnings in an effort to
discourage smokers and potential smokers from
smoking.
Changchun
MIDSOUTH
Nanchang
Shenzhen
9
City Profiles
T
he results of the CCATS survey have been presented so far by
specific topics. In this section, the most significant features
about each city are listed, including the most notable survey
results, updates on the tobacco control regulations, as well as
essential demographic and economic indicators. Note that when
an estimate for a city is described as the “highest” or “lowest”,
the comparison is made only among the 14 participating cities of
the study.
33
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
North Region
Anshan
Beijing
Urban population: 1,680,279
Urban population: 14,251,804
Annual urban disposable income per capita: ¥26,662
Current tobacco smoking prevalence: male
17.6%
49.5%
CITY PROFILES
Northeast Region
44.0%
Annual urban disposable income per capita: ¥40,321
female
Current tobacco smoking prevalence: male
2.8%
41.5%
female
Percentage of current tobacco smokers who tried quitting smoking in the past 12 months was second lowest
3.1%
Highest percentage of SHS exposure among adults at home
2.1%
Lowest percentage of SHS exposure among adults on public transportation
Beijing Municipal Legislation on Tobacco Control, the most comprehensive local tobacco control legislation so far,
will take effect on June 1, 2015
Anshan Municipal Ordinance on Smoking Control in Public Places took effect in January 2013
Changchun
Urban population: 2,190,387
Annual urban disposable income per capita: ¥26,034
Current tobacco smoking prevalence: male
21.2%
43.2%
Tangshan
female
Urban population: 942,069
3.8%
Annual urban disposable income per capita: ¥26,647
Highest percentage of adults who were daily smokers
Lowest percentage of adults who noticed
anti-smoking messages in newspapers/magazines
41.6%
Current tobacco smoking prevalence: male
55.0%
6.8%
Changchun Municipal Ordinance on Preventing Harms of Tobacco Smoke took effect in March 2014
70.5%
Urban population: 3,237,874
Annual urban disposable income per capita: ¥25,197
6.8%
female
72.0%
Second highest for TV
Highest awareness of the diseases caused by SHS among adults
Quit ratio among ever daily smokers ranked lowest along with Tangshan
28.9%
Tianjin
Highest percentage of adults who noticed
tobacco advertising at point of sale
Urban population: 4,070,148
Annual urban disposable income per capita: ¥32,658
Haerbin Municipal Legislation on Preventing Harms by Secondhand Smoke took effect in May 2013
Current tobacco smoking prevalence: male
Shenyang
Lowest percentage of adults
who supported prohibiting smoking in:
Urban population: 3,404,717
Annual urban disposable income per capita: ¥29,074
Current tobacco smoking prevalence: male
44.8%
93.2%
88.1%
female
indoor workplaces
Highest percentage of current smokers who
visited HCPs in the past 12 months and were
advised to quit by HCPs
health care facilities
86.2%
5.0%
Highest current smoking prevalence, overall and for male and females
70.2%
57.2%
Tangshan Municipal Ordinance on Managing Harms of Secondhand Smoke took effect in May 2014
2.7%
Second highest percentage of SHS exposure among adults in health care facilities
14.1%
1.9%
Quit ratio among ever daily smokers lowest, along with Haerbin
Highest percentage of adults who noticed
anti-cigarette smoking messages in newspapers/magazines
Haerbin
35.1%
female
or on TV
First city to conduct the China City Adult Tobacco Survey
Current tobacco smoking prevalence: male
40.6%
taxis
female
3.3%
Lowest percentage of current smokers
who attempted to quit in the past 12 months
80.8%
Highest percentage of SHS exposure among adults in restaurants
63.6%
and restaurants
As of October 2014, no tobacco control legislation
for public places.
34
16.4%
41.1%
24.8%
Lowest percentage of adults who mistakenly believed
low-tar cigarettes are less harmful than regular cigarettes
Tianjin Municipal Legislation on Smoking Control took effect in May 2012
35
Northwest Region
CITY PROFILES
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
East Region
Hangzhou
Urban population: 4,543,188
Annual urban disposable income per capita: ¥39,310
Current tobacco smoking prevalence: male
38.6%
female
Lanzhou
1.5%
Urban population: 1,976,428
Lowest percentage of current smokers who visited hospitals
in the past 12 months and were advised to quit by HCP
41.8%
Annual urban disposable income per capita: ¥20,767
Highest cost of purchasing 20 manufactured cigarettes: ¥19.9
Current tobacco smoking prevalence: male
Highest monthly expenditure on manufactured cigarettes: ¥301.7
Hangzhou Municipal Legislation on Smoking Control in Public Places took effect in March 2010
29.0%
Urban population: 1,967,024
42.2%
female
42.7%
45.0%
government
buildings/offices
14.6%
and SHS
46.9%
1.9%
Kelamayi
Highest percentage of SHS exposure among adults in the following indoor public places:
primary, secondary,
and high schools
（outdoor included)
44.0%
health care
facilities
43.9%
universities
32.5%
public
transportation
Urban population: 256,607
19.0%
Highest percentage of adults who mistakenly believed
low-tar cigarettes are less harmful than regular cigarettes
Annual urban disposable income per capita: ¥25,249
Current tobacco smoking prevalence: male
Has been struggling to pass the Nanchang Municipal Legislation on Controlling Harms by Secondhand Smoke since 2010
39.6%
41.6%
female
Lowest percentages of SHS exposure among adults in:
Urban population: 4,801,971
government buildings/offices,
health care facilities
Annual urban disposable income per capita: ¥35,227
17.7%
female
<10.0%
at home
27.1%
Kelamayi Municipal Ordinance on Banning Smoking in Public Places took effect in March 2013
0.9%
Lowest current smoking prevalence
15.9
17.1%
32.7%
0.4%
Second highest percentage of smokers
who attempted to quit in the past 12 months
Qingdao
Current tobacco smoking prevalence: male
1.8%
Lanzhou Municipal Legislation on Smoking Control in Public Places took effect in January 2014
Annual urban disposable income per capita: ¥26,151
Current tobacco smoking prevalence: male
female
Lowest percentage of adults who supported banning
smoking in bars/nightclubs
Lowest awareness
of diseases caused by smoking
Nanchang
41.2%
Highest average number of cigarettes
smoked per day among daily smokers
Highest quit ratio among ever daily smokers
primary, secondary,
Lowest percentage of SHS exposure
and high schools
among adults in the following indoor public places: （outdoor included)
21.7%
indoor
workplaces
26.2%
bars/
nightclubs
69.1%
Qingdao Municipal Legislation on Smoking Control took effect in September 2013
36
37
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Mid-South Region
Luoyang
Urban population: 905,150
Annual urban disposable income per capita: ¥24,820
Current tobacco smoking prevalence: male
56.5%
44.1%
female
1.0%
Second highest percentage of adults who noticed
anti-cigarette smoking messages in newspapers/magazines
Compared to non-smokers, smokers were significantly more likely
to mistakenly believe that low-tar cigarettes are less harmful than regular cigarettes: smokers
48.9%
non-smokers
22.5%
As of October 2014, no regulations on tobacco control established
10
Shenzhen
Urban population: 8,609,968
Annual urban disposable income per capita: ¥44,653
Current tobacco smoking prevalence: male
39.7%
33.9%
female
Highest percentage of smokers who attempted to quit in the past 12 months
Second lowest prevalence of current tobacco smoking for overall
42.4%
Appendices
0.7%
18.6%
and males
Lowest percentage of SHS exposure among adults in restaurants
Shenzhen Municipal Legislation on Smoking Control took effect in March 2014
38
39
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
APPENDICES
I: Data Tables, CCATS 2013–14
Population and Sample Characteristics
Population of urban adults 15 Years and above
(in thousands)
Location
Overall
Tobacco Smoking
Female
Overall
Male
Female
Overall
Location
841
840
2,346
1,178
1,168
97.5%
Anshan
Male
Anshan
1,680
Beijing
14,252
7,297
6,955
3,838
1,885
1,953
85.9%
2,190
1,096
1,095
2,213
1,026
1,187
92.2%
Changchun
Prevalence of current daily tobacco smoking
(%, 95% CI)
Response rate
(%)
Number of interviews
Overall
20.8
[18.3 - 23.6]
Beijing
19.8
Changchun
21.2
Male
Percentage of daily smokers among current tobacco smokers
(%, 95% CI)
Overall
Female
39.8
[34.7 - 45.1]
1.9
[1.2 - 3.0]
89.1
[18.2 - 21.5]
37.3
[35.1 - 39.6]
1.4
[0.9 - 2.3]
[18.6 - 24.1]
39.4
[34.8 - 44.1]
3.1
[2.1 - 4.6]
16.7
[13.4 - 20.6]
31.3
[24.9 - 38.4]
2.2
[1.2 - 4.0]
88.7
Male
[83.9 - 92.8]
90.5
89.0
[85.9 - 91.4]
90.0
90.4
[84.6 - 94.2]
91.1
[82.7 - 92.8]
89.1
Female
[84.9 - 94.1]
68.1
[49.4 - 82.4]
[86.9 - 92.4]
67.8
[44.9 - 84.4]
[84.8 - 95.0]
82.4
[67.7 - 91.2]
[82.2 - 93.5]
83.3
[59.4 - 94.4]
Haerbin
3,238
1,613
1,625
1,966
958
1,008
82.0%
Haerbin
Hangzhou
4,543
2,333
2,210
2,029
948
1,081
85.9%
Hangzhou
16.4
[12.2 - 21.6]
31.4
[23.5 - 40.6]
0.5
[0.2 - 1.1]
79.9
[70.2 - 87.0]
81.5
[72.6 - 88.1]
~
~
Kelamayi
257
130
127
1,970
992
978
79.8%
Kelamayi
16.3
[13.9 - 19.0]
31.9
[26.4 - 38.1]
0.3
[0.1 - 0.9]
76.6
[67.8 - 83.6]
76.7
[68.0 - 83.7]
~
~
Lanzhou
1,976
1,013
963
2,166
1,026
1,140
90.6%
Lanzhou
18.1
[14.8 - 21.9]
33.8
[27.7 - 40.6]
1.5
[0.9 - 2.4]
82.1
[75.6 - 87.3]
82.2
[75.8 - 87.1]
~
~
Luoyang
905
463
442
2,188
1,019
1,169
91.4%
Luoyang
18.9
[15.6 - 22.7]
36.2
[29.5 - 43.4]
0.7
[0.2 - 2.4]
81.9
[72.1 - 88.8]
82.1
[72.2 - 89.0]
~
~
Nanchang
1,967
1,006
961
2,282
1,071
1,211
96.2%
Nanchang
19.2
[17.2 - 21.4]
36.2
[31.9 - 40.7]
1.5
[1.0 - 2.2]
85.4
[79.1 - 90.0]
85.8
[79.3 - 90.5]
75.5
Qingdao
4,802
2,526
2,276
2,041
984
1,057
84.7%
Qingdao
13.9
[11.0 - 17.5]
26.2
[20.1 - 33.2]
0.3
[0.1 - 1.0]
78.8
[70.0 - 85.6]
79.9
[71.3 - 86.4]
~
Shenyang
3,405
1,671
1,733
1,957
965
992
81.4%
Shenyang
20.7
[18.1 - 23.6]
38.8
[33.5 - 44.5]
3.2
[1.9 - 5.4]
84.5
[78.0 - 89.4]
86.7
[79.8 - 91.5]
65.4
Shenzhen
8,610
4,634
3,976
2,043
953
1,090
89.0%
Shenzhen
12.0
[9.8 - 14.6]
21.8
[17.8 - 26.5]
0.5
[0.3 - 1.0]
64.5
[57.5 - 71.0]
64.4
[57.3 - 70.9]
~
Tangshan
Tianjin
GATS 2010
Urban
[52.8 - 89.5]
~
[51.8 - 76.9]
~
942
473
469
2,135
1,041
1,094
80.2%
Tangshan
17.3
[13.4 - 22.0]
32.9
[25.5 - 41.3]
1.5
[0.8 - 2.9]
81.1
[73.5 - 87.0]
81.0
[73.4 - 86.9]
83.0
[61.4 - 93.7]
4,070
2,026
2,044
1,977
962
1,015
85.7%
Tianjin
20.1
[17.6 - 22.8]
37.5
[33.1 - 42.1]
2.8
[2.0 - 3.9]
90.9
[86.2 - 94.1]
91.3
[86.9 - 94.3]
86.7
[70.0 - 94.8]
492,389
248,600
243,789
5,832
2,787
3,045
–
GATS 2010
Urban
22.0
[19.8 - 24.4]
41.7
[38.4 - 45.1]
2.0
[1.4 - 2.9]
84.4
[80.7 - 87.5]
84.8
[81.1 - 87.8]
77.1
[60.0 - 88.3]
~: Indicates estimate based on less than 25 unweighted cases and has been suppressed.
–: Data not available.
Tobacco Smoking
Prevalence of current tobacco smoking (%, 95% CI)
Location
Overall
Male
Tobacco Smoking
Average number of cigarettes smoked per day
among current daily cigarette smokers*
(mean, 95%CI)
Weighted number of tobacco smokers (In thousands)
Female
Overall
Male
Female
Location
Overall
Male
Percentage of current daily cigarette smokers who smoke
20 or more cigarettes per day*
(%, 95% CI)
Overall
Female
Male
Female
Anshan
23.4
[20.9 - 26.0]
44.0
[39.4 - 48.7]
2.8
[1.8 - 4.3]
393
370
23
Anshan
15.5
[13.7 - 17.3]
15.6
[13.7 - 17.4]
13.5
[10.4 - 16.5]
43.0
[33.3 - 53.2]
43.3
[33.3 - 54.0]
36.3
[18.5 - 58.9]
Beijing
22.3
[20.5 - 24.1]
41.5
[38.7 - 44.3]
2.1
[1.4 - 3.2]
3,174
3,026
147
Beijing
14.0
[12.3 - 15.8]
14.1
[12.3 - 15.9]
11.8
[9.2 - 14.5]
35.9
[27.0 - 46.0]
36.7
[27.0 - 47.5]
16.5
[6.7 - 35.2]
Changchun
23.5
[20.6 - 26.7]
43.2
[38.6 - 47.9]
3.8
[2.5 - 5.6]
515
473
41
Changchun
14.9
[13.5 - 16.3]
15.3
[13.8 - 16.7]
10.7
[8.0 - 13.5]
39.5
[31.0 - 48.5]
40.7
[31.8 - 50.3]
23.5
[10.1 - 45.8]
Haerbin
18.8
[15.5 - 22.6]
35.1
[28.6 - 42.3]
2.7
[1.6 - 4.5]
610
566
44
Haerbin
13.7
[12.6 - 14.8]
13.9
[12.8 - 15.1]
~
~
34.6
[28.4 - 41.4]
35.2
[29.0 - 41.9]
~
~
Hangzhou
20.5
[16.6 - 25.1]
38.6
[30.8 - 46.9]
1.5
[0.8 - 2.8]
932
900
32
Hangzhou
13.5
[12.2 - 14.8]
13.6
[12.3 - 14.9]
~
~
33.1
[26.1 - 41.0]
33.3
[26.1 - 41.3]
~
~
Kelamayi
21.3
[18.5 - 24.3]
41.6
[36.1 - 47.4]
0.4
[0.1 - 1.2]
55
54
1
Kelamayi
13.9
[12.4 - 15.4]
13.9
[12.4 - 15.4]
~
~
34.8
[27.8 - 42.5]
35.1
[28.1 - 42.8]
~
~
Lanzhou
22.0
[18.4 - 26.0]
41.2
[34.6 - 48.2]
1.8
[1.1 - 3.0]
435
417
17
Lanzhou
13.2
[11.6 - 14.8]
13.3
[11.7 - 14.9]
~
~
32.0
[24.6 - 40.4]
32.5
[24.9 - 41.1]
~
~
~
41.3
[31.7 - 51.7]
40.6
[31.0 - 51.0]
~
[9.1 - 14.5]
47.5
[40.8 - 54.3]
48.4
[41.7 - 55.1]
25.0
~
49.3
[40.9 - 57.8]
49.4
[41.0 - 57.9]
~
[8.7 - 15.8]
39.5
[31.8 - 47.8]
40.4
[32.1 - 49.3]
28.7
Luoyang
23.0
[19.6 - 26.9]
44.1
[37.5 - 50.9]
1.0
[0.3 - 2.7]
209
204
4
Luoyang
14.6
[12.6 - 16.5]
14.4
[12.5 - 16.2]
~
Nanchang
22.5
[20.3 - 25.0]
42.2
[38.1 - 46.3]
1.9
[1.3 - 2.8]
443
425
19
Nanchang
15.6
[14.8 - 16.5]
15.8
[14.9 - 16.6]
11.8
Qingdao
17.7
[14.8 - 20.9]
32.7
[27.0 - 39.1]
0.9
[0.4 - 2.1]
849
827
21
Qingdao
15.9
[14.8 - 16.9]
15.9
[14.8 - 16.9]
~
Shenyang
24.5
[21.7 - 27.6]
44.8
[39.5 - 50.2]
5.0
[3.1 - 8.0]
835
749
86
Shenyang
14.8
[13.2 - 16.4]
15.1
[13.2 - 16.9]
12.2
~
[9.5 - 51.5]
~
[13.1 - 51.8]
Shenzhen
18.6
[15.9 - 21.6]
33.9
[29.1 - 39.1]
0.7
[0.4 - 1.2]
1,600
1,571
28
Shenzhen
15.0
[13.6 - 16.4]
15.1
[13.7 - 16.5]
~
~
44.4
[38.5 - 50.5]
44.8
[38.6 - 51.1]
~
~
Tangshan
21.3
[17.2 - 26.1]
40.6
[32.8 - 48.9]
1.9
[1.0 - 3.4]
201
192
9
Tangshan
15.0
[13.7 - 16.3]
15.0
[13.6 - 16.4]
~
~
45.8
[38.4 - 53.4]
45.7
[37.5 - 54.2]
~
~
Tianjin
22.1
[19.4 - 25.0]
41.1
[36.3 - 46.0]
3.3
[2.3 - 4.7]
899
832
67
Tianjin
15.0
[13.8 - 16.3]
15.3
[14.0 - 16.6]
11.8
[9.0 - 14.6]
41.6
[35.2 - 48.3]
42.6
[36.0 - 49.4]
29.3
[13.2 - 52.9]
GATS 2010
Urban
26.1
[24.0 - 28.3]
49.2
[46.1 - 52.2]
2.6
[1.9 - 3.7]
128,676
122,268
6,408
GATS 2010
Urban
15.7
[14.8 - 16.5]
15.8
[14.9 - 16.7]
13.1
[11.5 - 14.6]
42.5
[36.9 - 48.4]
43.0
[37.2 - 48.9]
33.4
[20.5 - 49.2]
~: Indicates estimate based on less than 25 unweighted cases and has been suppressed.
*: Estimates are calculated with outliers removed.
40
41
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Percentage of adults
who ever heard of
e-cigarettes (%, 95% CI)
Location
Percentage of adults who were current
tobacco smokers among current
e-cigarette users (%, 95% CI)
Percentage of adults
who currently use e-cigarettes (%, 95% CI)
Overall
Overall
APPENDICES
Cessation
Electronic-Cigarette Use
Smoker
Non-smoker
Percentage of current tobacco smokers attempting to quit for 24 hours or
longer in past 12 months (%, 95% CI)
Overall
Location
Overall
Male
Percentage of current tobacco smokers intending to quit
in next 12 months (%, 95% CI)
Overall
Female
Male
Female
Anshan
43.6
[32.4 - 55.5]
0.5
[0.2 - 1.0]
1.9
[0.9 - 3.9]
0.1
[0.0 - 0.5]
90.1
[51.4 - 98.7]
Anshan
14.6
[9.4 - 21.9]
14.2
[9.0 - 21.6]
22.3
[11.0 - 39.9]
7.9
[5.1 - 12.1]
7.1
[4.4 - 11.4]
20.7
[7.2 - 46.7]
Beijing
44.8
[40.4 - 49.3]
1.3
[0.7 – 2.5]
5.7
[3.2 - 10.1]
0.1
[0.0 - 0.4]
94.8
[85.5 - 98.3]
Beijing
15.2
[11.5 - 19.8]
15.0
[11.4 - 19.4]
20.2
[8.4 - 41.1]
12.3
[8.2 - 17.9]
11.7
[7.5 - 17.9]
22.9
[9.1 - 46.9]
Changchun
53.9
[47.1 - 60.6]
0.8
[0.4 - 1.5]
3.3
[1.6 - 6.6]
0.0
–
100.0
–
Changchun
18.8
[13.2 - 26.0]
17.8
[12.4 - 24.9]
30.8
[16.6 - 50.0]
11.6
[7.9 - 16.8]
10.8
[6.9 - 16.3]
21.3
[12.7 - 33.7]
Haerbin
43.9
[34.3 - 54.0]
1.3
[0.7 - 2.4]
5.8
[3.1 - 10.5]
0.3
[0.1 - 0.7]
83.4
[66.3 - 92.8]
Haerbin
15.0
[8.7 - 24.5]
14.4
[8.2 - 24.0]
~
~
12.1
[7.7 - 18.5]
12.7
[7.9 - 19.8]
4.9
[1.0 - 20.8]
Hangzhou
44.0
[40.8 - 47.3]
0.4
[0.1 - 0.9]
1.7
[0.6 - 4.5]
0.0
[0.0 - 0.1]
97.1
[76.9 - 99.7]
Hangzhou
21.0
[16.5 - 26.3]
21.2
[16.4 - 27.0]
~
~
11.7
[5.5 - 22.9]
11.4
[5.2 - 23.2]
~
~
Kelamayi
42.5
[37.1 - 48.1]
0.7
[0.4 - 1.4]
3.0
[1.6 - 5.4]
0.1
[0.0 - 1.0]
86.8
[42.3 - 98.3]
Kelamayi
23.7
[17.0 - 32.1]
23.8
[17.0 - 32.1]
~
~
13.3
[9.3 - 18.7]
13.4
[9.4 - 18.8]
~
~
Lanzhou
47.1
[34.5 - 60.0]
0.9
[0.5 - 1.6]
3.5
[2.0 - 6.2]
0.1
[0.0 - 0.7]
88.7
[57.2 - 97.9]
Lanzhou
17.6
[12.7 - 23.8]
17.5
[12.7 - 23.8]
~
~
13.1
[8.8 - 19.1]
13.1
[8.7 - 19.2]
~
~
Luoyang
62.7
[54.0 - 70.7]
1.7
[0.7 - 4.3]
6.8
[2.4 - 17.5]
0.2
[0.1 - 0.6]
92.1
[69.0 - 98.4]
Luoyang
17.9
[11.4 - 27.1]
17.8
[11.2 - 27.0]
~
~
13.4
[9.0 - 19.4]
13.4
[9.1 - 19.2]
~
~
Nanchang
54.3
[49.5 - 59.0]
0.3
[0.2 - 0.7]
1.2
[0.5 - 2.8]
0.1
[0.0 - 0.3]
~
~
Nanchang
17.9
[13.1 - 24.0]
18.5
[13.5 - 24.7]
5.6
[1.3 - 20.8]
10.2
[6.7 - 15.2]
10.5
[6.9 - 15.7]
3.0
[0.4 - 18.3]
Qingdao
41.3
[33.4 - 49.6]
0.1
[0.0 - 0.3]
0.4
[0.1 - 1.9]
0.0
–
~
~
Qingdao
17.8
[11.9 - 25.7]
17.9
[11.9 - 26.0]
Shenyang
46.9
[38.3 - 55.7]
0.8
[0.4 - 1.6]
2.8
[1.4 - 5.4]
0.2
[0.0 - 1.1]
82.2
[41.6 - 96.8]
Shenyang
11.1
[7.4 - 16.4]
11.9
[7.7 - 17.8]
Shenzhen
51.5
[44.1 - 58.8]
0.6
[0.4 - 1.1]
3.3
[2.0 - 5.6]
0.0
[0.0 - 0.2]
97.2
[78.8 - 99.7]
Shenzhen
30.0
[22.8 - 38.3]
29.9
[22.7 - 38.3]
~
Tangshan
48.0
[40.8 - 55.3]
0.7
[0.3 - 1.6]
3.0
[1.5 - 6.0]
0.0
[0.0 - 0.3]
95.5
[77.5 - 99.2]
Tangshan
12.5
[8.3 - 18.4]
12.7
[8.3 - 19.0]
7.5
Tianjin
45.0
[39.0 - 51.2]
0.4
[0.2 - 1.0]
1.9
[0.7 - 4.6]
0.0
[0.0 - 0.1]
97.7
[80.9 - 99.8]
Tianjin
10.7
[7.0 - 16.2]
10.3
[6.4 - 16.2]
16.2
–
–
–
–
–
GATS 2010
Urban
–
–
–
–
–
–
–
–
–
GATS 2010
Urban
–
–: Data not available.
~: Indicates estimate based on less than 10 unweighted cases and has been suppressed.
~
4.5
~
14.2
[8.1 - 23.7]
14.6
[8.3 - 24.3]
~
~
[1.2 - 14.7]
13.6
[8.8 - 20.4]
14.6
[9.6 - 21.5]
5.0
[1.1 - 19.6]
~
22.0
[16.7 - 28.5]
22.3
[16.8 - 28.8]
~
~
[2.2 - 22.7]
10.8
[7.0 - 16.3]
9.9
[6.2 - 15.6]
29.2
[12.0 - 55.6]
[4.6 - 43.4]
9.9
[7.1 - 13.7]
10.2
[7.5 - 13.6]
7.4
[1.8 - 25.8]
–
13.5
[10.0 - 18.1]
13.1
[9.3 - 18.0]
22.2
[13.2 - 34.7]
–: Data not available.
~: Indicates estimate based on less than 25 unweighted cases and has been suppressed.
Cessation
Cessation
Percentage of former daily tobacco smokers
among ever daily tobacco smokers (%, 95% CI)
Overall
Location
Anshan
12.2
Beijing
Changchun
Male
[7.7 - 18.8]
11.0
9.9
[6.6 - 14.5]
9.6
[6.2 - 14.6]
Percentage of current tobacco smokers attempting to quit
in past 12 months (%, 95% CI)
Overall
Female
[6.6 - 17.7]
32.2
[16.4 - 53.5]
17.6
9.6
[6.4 - 14.2]
8.7
[5.6 - 13.3]
15.5
[9.1 - 25.1]
22.8
19.7
[10.1 - 34.8]
24.5
[11.6 - 25.7]
Male
16.6
[10.6 - 24.9]
[17.4 - 29.2]
22.5
[16.8 - 29.6]
[18.4 - 31.8]
23.2
[17.3 - 30.4]
Female
34.3
Percentage of current tobacco
smokers who visited health care
providers in past 12 months
(%, 95% CI)
Percentage of current tobacco
smokers advised to quit by health
care providers in past 12 months*
(%, 95% CI)
Overall
Overall
Location
[17.0 - 57.0]
Anshan
27.3
[15.8 - 42.8]
27.3
[14.0 - 46.3]
Beijing
29.3
[21.3 - 38.8]
58.1
39.2
[22.7 - 58.7]
Changchun
27.8
[19.7 - 37.7]
58.2
[20.6 - 49.9]
51.0
Distribution of ever tobacco smokers
by quit status (%, 95% CI)
Former smoker
[22.4 - 79.0]
Current smokers intending Current smokers not intending
to quit in 12 months
to quit in 12 months
15.4
[10.5 - 21.9]
6.7
[4.3 - 10.3]
77.9
[71.4 - 83.4]
[49.1 - 66.5]
14.6
[10.0 - 20.8]
10.5
[7.0 - 15.4]
74.9
[68.1 - 80.7]
[45.8 - 69.5]
13.5
[9.2 - 19.3]
10.0
[6.9 - 14.4]
76.5
[69.2 - 82.5]
6.8
[4.0 - 11.2]
7.1
[4.2 - 11.8]
1.5
[0.2 - 11.0]
22.8
[16.0 - 31.4]
22.0
[15.1 - 30.8]
33.7
Haerbin
19.9
[14.9 - 26.2]
49.7
[32.9 - 66.7]
12.3
[8.1 - 18.2]
10.7
[6.7 - 16.6]
77.1
[71.3 - 82.0]
Hangzhou
12.8
[8.0 - 19.9]
12.7
[8.0 - 19.6]
~
~
26.3
[21.7 - 31.6]
26.6
[21.5 - 32.3]
~
~
Hangzhou
25.1
[16.8 - 35.7]
41.8
[22.9 - 63.5]
19.2
[13.4 - 26.8]
9.4
[4.4 - 18.9]
71.4
[62.4 - 78.9]
Kelamayi
16.9
[11.4 - 24.4]
16.2
[11.1 - 23.1]
~
~
39.6
[33.0 - 46.5]
39.2
[32.5 - 46.3]
~
~
Kelamayi
30.4
[22.6 - 39.5]
46.4
[29.5 - 64.1]
20.0
[14.5 - 26.9]
10.6
[7.4 - 15.1]
69.4
[62.5 - 75.4]
Lanzhou
9.7
[5.4 - 16.9]
9.7
[5.5 - 16.7]
~
~
25.9
[20.5 - 32.1]
25.7
[20.4 - 32.0]
~
~
Lanzhou
26.1
[16.9 - 38.0]
59.4
[34.4 - 80.3]
14.7
[8.7 - 23.6]
11.2
[7.3 - 16.7]
74.2
[66.5 - 80.6]
Luoyang
15.7
[10.4 - 23.0]
15.2
[9.9 - 22.6]
~
~
Luoyang
41.9
[29.1 - 55.8]
53.9
[33.3 - 73.2]
20.8
[14.5 - 29.0]
10.6
[7.2 - 15.3]
68.6
[59.9 - 76.1]
Nanchang
14.2
[11.4 - 17.6]
14.3
[11.4 - 17.7]
13.6
[7.9 - 36.6]
Nanchang
25.9
[21.4 - 31.0]
48.6
[39.3 - 58.0]
17.7
[14.5 - 21.5]
8.4
[5.5 - 12.5]
73.9
[69.1 - 78.2]
Qingdao
17.1
[11.8 - 24.1]
17.4
[12.1 - 24.4]
~
Shenyang
12.5
[8.5 - 18.0]
11.7
[7.7 - 17.4]
20.3
Shenzhen
13.1
[6.6 - 24.4]
12.9
[6.3 - 24.6]
~
Haerbin
~
24.3
[17.7 - 32.4]
24.0
[17.4 - 32.2]
~
[2.2 - 52.4]
25.4
[20.0 - 31.6]
25.7
[20.3 - 32.0]
18.3
~
25.7
[19.2 - 33.6]
25.8
[19.1 - 33.7]
~
[10.3 - 36.2]
20.7
[15.1 - 27.6]
21.4
[15.6 - 28.7]
14.2
~
39.7
[34.2 - 45.4]
39.7
[34.3 - 45.4]
~
Qingdao
39.9
[28.8 - 52.2]
70.1
[51.4 - 83.9]
22.9
[16.3 - 31.2]
11.0
[6.3 - 18.5]
66.1
[56.8 - 74.3]
[6.3 - 28.8]
Shenyang
25.3
[18.7 - 33.2]
70.2
[48.3 - 85.6]
16.8
[12.2 - 22.9]
11.3
[7.4 - 16.8]
71.9
[63.6 - 78.9]
~
Shenzhen
44.4
[35.9 - 53.2]
57.2
[34.1 - 77.6]
20.2
[14.2 - 28.0]
17.6
[13.5 - 22.6]
62.2
[54.0 - 69.8]
~
6.8
[3.8 - 11.6]
6.1
[3.3 - 11.0]
19.0
[7.5 - 40.6]
19.6
[14.1 - 26.4]
19.7
[14.1 - 26.8]
17.1
[8.2 - 32.3]
Tangshan
18.8
[13.4 - 25.7]
61.6
[46.0 - 75.1]
14.2
[9.4 - 21.0]
9.3
[6.1 - 13.9]
76.5
[68.9 - 82.8]
Tianjin
14.7
[10.5 - 20.2]
13.7
[9.6 - 19.2]
26.1
[14.5 - 42.2]
16.4
[11.9 - 22.2]
16.2
[11.4 - 22.5]
19.2
[6.9 - 43.4]
Tianjin
30.1
[21.6 - 40.2]
66.5
[56.0 - 75.5]
18.3
[13.6 - 24.2]
8.1
[5.7 - 11.4]
73.6
[68.3 - 78.2]
GATS 2010
Urban
13.8
[10.9 - 17.3]
13.7
[11.0 - 17.1]
14.3
[6.5 - 28.4]
9.4
[7.3 - 12.1]
9.1
[7.0 - 11.8]
14.7
[8.0 - 25.5]
GATS 2010
Urban
27.1
[22.7 - 32.0]
30.7
[25.6 - 36.4]
16.9
[13.7 - 20.6]
11.2
[8.5 - 14.7]
71.9
[65.8 - 77.2]
Tangshan
~: Indicates estimate based on less than 25 unweighted cases and has been suppressed.
*Among current smokers who visited health care providers in past 12 months.
42
43
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Government
buildings/offices
Location
Location
Health care facilities
Restaurants
Bars/nightclubs
Primary/secondary/
Public transportation high/technical schools
(indoor & outdoor)
Universities
Bars/nightclubs
Location
Location
Taxis
Primary/secondary/
high/technical schools
[90.1 - 96.2]
98.6
Anshan
21.7
[10.2 - 40.2] 20.0
[10.8 - 34.0]
74.0 [64.2 - 81.8] 95.7 [83.3 - 99.0]
6.3
[4.3 - 9.2]
41.7
[26.7 - 58.5]
19.6 [8.1 - 40.5]
Anshan
66.8
[55.0 - 76.8]
93.8
Beijing
19.9
[15.0 - 25.9] 13.4
[10.9 - 16.4]
65.3
3.1
[2.2 - 4.5]
33.4
[25.3 - 42.6]
26.0 [19.5 - 33.8]
Beijing
61.2
[50.6 - 70.8]
94.5
[90.8 - 96.8]
57.5
[48.4 - 66.1]
90.8
[86.2 - 94.0]
[57.8 - 72.1]
89.1
[81.2 - 93.9]
Percentage of adults aware of current complete
smoking bans in indoor public places
(%, 95% CI)
Percentage of adults supporting smoking bans in indoor public places
(%, 95% CI)
Percentage of adults who were exposed to smoke in indoor public places in the past 30 days (%, 95% CI)
Universities
Workplaces
[97.0 - 99.3]
97.3
[93.8 - 98.8]
38.7
[25.7 - 53.4]
99.0
[97.8 - 99.5]
95.3
[91.4 - 97.5]
~
98.5
[96.6 - 99.3]
95.8
[93.8 - 97.1]
~
Health care facilities
57.9
[43.3 - 71.3]
~
61.7
[48.8 - 73.2]
~
56.3
[44.3 - 67.5]
Changchun
32.1
[25.3 - 39.7] 22.5
[16.3 - 30.3]
72.7 [62.0 - 81.3]
78.9
[61.4 - 89.8]
11.5
[7.4 - 17.5]
33.3
[24.4 - 43.5]
17.9 [12.2 - 25.6]
Changchun
Haerbin
38.2
[24.4 - 54.3] 28.9
[19.6 - 40.4]
65.0 [53.3 - 75.1]
74.7
[58.7 - 85.9]
10.1
[6.0 - 16.6]
30.4
[19.7 - 43.7]
24.5 [15.9 - 35.8]
Haerbin
65.1
[51.0 - 77.0]
92.0
[86.8 - 95.3]
95.8
[90.6 - 98.2]
94.5
[89.5 - 97.2]
64.6
[51.9 - 75.6]
69.7
[58.1 - 79.3]
47.4
[40.7 - 54.3]
95.9
[94.3 - 97.1]
98.3
[97.4 - 98.8]
95.6
[94.0 - 96.8]
~
~
40.9
[30.5 - 52.3]
Hangzhou
20.6
Kelamayi
9.3
[14.9 - 27.8] 16.3
[12.7 - 20.6]
58.1 [52.0 - 63.9] 92.5 [86.3 - 96.0]
5.5
[3.5 - 8.8]
30.7
[22.2 - 40.7]
20.5 [12.8 - 31.2]
Hangzhou
[5.7 - 14.9]
[4.9 - 10.7]
53.6 [43.5 - 63.4] 90.2 [73.8 - 96.8]
6.2
[4.2 - 9.0]
23.3
[16.3 - 32.3]
23.5 [8.3 - 51.1]
Kelamayi
47.7
[39.7 - 55.9]
91.5
[87.4 - 94.4]
96.5
[93.6 - 98.1]
93.3
[89.1 - 96.0]
44.7
[33.9 - 56.0]
58.1
[45.3 - 70.0]
29.0
[21.6 - 37.8]
91.7
[82.6 - 96.3]
95.9
[83.6 - 99.1]
91.6
[80.4 - 96.7]
~
~
56.9
[43.0 - 69.8]
47.7
[37.4 - 58.3]
93.8
[89.8 - 96.3]
98.9
[97.9 - 99.4]
96.7
[94.7 - 98.0]
~
~
51.7
[37.2 - 65.9]
7.3
Lanzhou
40.0
[31.7 - 49.0] 10.3
[6.9 - 15.2]
69.9
[77.5 - 95.1]
8.1
[5.3 - 12.3]
39.4
[24.2 - 56.9]
24.9 [14.7 - 38.8]
Lanzhou
Luoyang
31.6
[18.7 - 48.0] 15.8
[11.2 - 21.9]
78.2 [70.0 - 84.6] 90.2 [73.3 - 96.9]
11.1
[6.7 - 18.0]
38.7
[26.7 - 52.3]
23.9 [14.4 - 37.0]
Luoyang
Nanchang
44.0
[36.3 - 52.1] 43.9
[38.3 - 49.7]
79.9
95.3 [82.0 - 98.9]
19.0 [15.2 - 23.4] 45.0
[37.8 - 52.5]
32.5 [23.5 - 42.9]
Nanchang
67.9
[62.6 - 72.7]
93.1
[90.3 - 95.2]
97.5
[95.6 - 98.5]
94.8
[91.7 - 96.8]
~
~
34.1
[23.7 - 46.4]
Qingdao
14.7
[9.1 - 23.0]
[8.3 - 23.0]
59.0 [48.3 - 69.0]
69.1
[46.8 - 85.0]
11.9
[4.7 - 27.0]
21.7
[14.2 - 31.6]
26.6 [16.5 - 40.1]
Qingdao
62.8
[52.8 - 71.8]
92.7
[87.4 - 95.9]
95.2
[91.0 - 97.5]
92.0
[85.9 - 95.6]
44.7
[33.0 - 57.0]
60.1
[47.9 - 71.2]
Shenyang
29.6
[17.2 - 46.0] 23.9
[16.6 - 33.1]
78.1 [66.6 - 86.4] 99.2 [92.8 - 99.9]
18.1
[9.9 - 30.7]
43.9
[29.0 - 60.0]
27.2 [14.6 - 44.9]
Shenyang
42.0
[29.2 - 55.9]
86.2
[77.8 - 91.8]
95.3
[82.0 - 98.9]
92.8
[81.1 - 97.5]
~
~
55.7
[40.5 - 69.9]
Shenzhen
23.6
[19.6 - 28.1] 18.3
[14.9 - 22.3]
42.4 [36.7 - 48.3] 76.9
[70.6 - 82.1]
7.3
[3.9 - 13.3]
27.9
[20.7 - 36.4]
14.5 [8.8 - 23.1]
Shenzhen
52.0
[45.7 - 58.3]
93.0
[88.4 - 95.9]
98.7
[97.9 - 99.2]
94.7
[92.8 - 96.2]
47.4
[40.0 - 55.0]
57.6
[50.1 - 64.8]
Tangshan
21.2
[14.1 - 30.6]
[10.3 - 24.3]
71.8 [62.6 - 79.5] 86.0 [72.5 - 93.5]
6.7
[3.9 - 11.1]
23.9
[14.6 - 36.5]
13.8 [7.2 - 24.9]
Tangshan
62.1
[49.2 - 73.5]
94.0
[88.9 - 96.9]
97.5
[95.2 - 98.7]
96.6
[94.5 - 98.0]
~
~
56.1
[43.0 - 68.4]
18.0 [10.9 - 28.3]
Tianjin
57.4
[48.1 - 66.3]
95.0
[91.9 - 96.9]
98.3
[97.4 - 98.9]
97.3
[96.3 - 98.1]
48.9
[40.1 - 57.8]
67.3
[56.1 - 76.8]
–
–
–
–
–
–
–
–
–
–
–
–
14.1
16.1
[58.7 - 79.1]
[74.9 - 84.1]
89.1
Tianjin
34.6
[24.4 - 46.4] 18.4
[12.4 - 26.5]
80.8 [75.6 - 85.1]
95.5
[89.7 - 98.1]
GATS 2010
Urban
56.3
[47.5 - 64.7] 32.2
[27.0 - 37.9]
88.5 [85.5 - 91.0]
–
–
9.4
[6.9 - 12.7]
40.3
[27.6 - 54.4]
26.8 [19.2 - 36.0] 36.2
[28.6 - 44.7]
–
–
GATS 2010
Urban
~: Smoking bans not in place.
–: Data not available.
–: Data not available.
Secondhand smoke exposure
Exposure to smoke at indoor
workplaces* (%, 95% CI)
Exposure to smoke in the
home* (%, 95% CI)
Overall
Overall
Location
Anshan
42.3
[32.5 - 52.6]
Secondhand smoke exposure
Percentage of adults supporting smoking bans
in indoor public places:
(%, 95% CI)
Workplaces
49.5
[43.8 - 55.2]
94.9
Health care facilities
[90.8 - 97.2]
97.8
Percentage of adults aware of current complete smoking bans in indoor public places
(%, 95% CI)
Restaurants
Restaurants
Location
Bars/nightclubs
Primary/secondary/high/
technical schools
Taxis
[95.2 - 99.0]
82.9
[74.9 - 88.7]
Anshan
26.0
[15.1 - 41.0]
19.5
[10.5 - 33.4]
61.6
[45.2 - 75.7]
63.9
Universities
[48.4 - 77.0]
55.7
[41.4 - 69.1]
Beijing
36.4
[31.0 - 42.1]
37.2
[31.4 - 43.4]
94.2
[89.7 - 96.8]
98.7
[97.8 - 99.2]
85.4
[79.3 - 89.9]
Beijing
~
~
~
~
57.8
[46.5 - 68.4]
64.6
[48.1 - 78.3]
~
~
Changchun
48.9
[41.2 - 56.6]
45.8
[37.2 - 54.6]
91.3
[86.4 - 94.6]
97.1
[95.3 - 98.2]
76.2
[69.4 - 81.8]
Changchun
~
~
~
~
~
~
63.1
[50.5 - 74.2]
~
~
Haerbin
40.8
[31.8 - 50.5]
37.2
[30.7 - 44.1]
92.9
[86.1 - 96.5]
94.9
[87.3 - 98.1]
81.2
[70.8 - 88.4]
Haerbin
52.7
[38.6 - 66.3]
–
–
79.6
[71.3 - 85.9]
77.9
[66.7 - 86.1]
74.0
[62.4 - 83.0]
Hangzhou
45.4
[41.7 - 49.2]
29.6
[23.0 - 37.3]
92.4
[90.1 - 94.2]
98.2
[97.0 - 98.9]
85.3
[79.7 - 89.6]
Hangzhou
~
~
~
~
72.2
[66.4 - 77.4]
41.1
[29.5 - 53.8]
~
~
Kelamayi
36.3
[27.7 - 46.0]
27.1
[22.8 - 31.9]
95.4
[92.7 - 97.2]
97.7
[95.6 - 98.8]
83.2
[75.7 - 88.7]
Kelamayi
28.2
[19.4 - 39.0]
13.5
[7.4 - 23.2]
69.6
[59.7 - 78.0]
66.6
[56.9 - 75.1]
49.4
[38.7 - 60.2]
Lanzhou
44.2
[33.9 - 55.0]
39.7
[32.0 - 47.9]
91.4
[78.1 - 96.9]
96.0
[87.6 - 98.8]
71.0
[60.9 - 79.3]
Lanzhou
~
~
~
~
~
~
59.4
[41.3 - 75.2]
~
~
Luoyang
52.3
[42.6 - 61.8]
30.7
[23.7 - 38.7]
94.8
[90.0 - 97.3]
99.1
[98.2 - 99.5]
79.8
[72.4 - 85.6]
Luoyang
~
~
~
~
~
~
56.2
[40.4 - 70.9]
~
~
Nanchang
59.6
[54.2 - 64.7]
43.6
[39.2 - 48.1]
93.3
[91.3 - 94.8]
98.0
[96.7 - 98.9]
86.2
[82.3 - 89.3]
Nanchang
~
~
~
~
~
~
35.2
[25.1 - 46.8]
~
~
Qingdao
26.2
[21.3 - 31.6]
37.8
[29.6 - 46.9]
92.8
[88.6 - 95.5]
95.3
[89.9 - 97.8]
80.1
[71.1 - 86.8]
Qingdao
35.4
[24.8 - 47.6]
24.0
[15.1 - 35.8]
63.9
[53.1 - 73.5]
61.2
[49.0 - 72.2]
55.2
[42.4 - 67.4]
Shenyang
50.9
[39.3 - 62.5]
41.6
[35.7 - 47.8]
88.1
[73.3 - 95.2]
93.2
[74.0 - 98.5]
63.6
[48.0 - 76.7]
Shenyang
~
~
~
~
~
~
62.8
[46.9 - 76.3]
~
~
Shenzhen
40.1
[35.2 - 45.3]
28.9
[23.6 - 34.8]
92.5
[89.4 - 94.7]
98.0
[96.3 - 98.9]
85.8
[80.7 - 89.8]
Shenzhen
48.0
[40.4 - 55.7]
~
~
56.5
[49.7 - 63.0]
65.7
[57.8 - 72.9]
54.9
[46.0 - 63.4]
Tangshan
45.3
[37.6 - 53.2]
35.2
[29.2 - 41.7]
95.0
[91.2 - 97.2]
97.5
[94.3 - 99.0]
77.9
[65.4 - 86.8]
Tangshan
~
~
~
~
~
~
63.3
[51.5 - 73.7]
~
~
Tianjin
43.1
[34.8 - 51.7]
37.0
[29.7 - 44.9]
92.7
[85.5 - 96.4]
97.4
[95.9 - 98.3]
81.7
[73.7 - 87.6]
Tianjin
~
~
~
~
77.2
[67.5 - 84.6]
67.9
[59.4 - 75.4]
62.7
[54.2 - 70.5]
GATS 2010
Urban
62.4
[57.0 - 67.6]
60.0
[56.4 - 63.5]
–
–
–
–
–
–
GATS 2010
Urban
–
–
–
–
–
–
–
–
–
–
~: Smoking bans not in place.
–: Data not available.
–: Data not available.
*: In the past 30 days.
44
45
APPENDICES
Secondhand smoke exposure
Secondhand smoke exposure
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Percentage of adults who noticed cigarette advertising at point of sale and various types of cigarette promotion in the past 30 days
(%, 95% CI)
Percentage of adults who were aware of specific diseases caused by smoking
(%, 95% CI)
7.6
Free sample
Sales prices
Coupons
Free gifts/discount on other
products
Stroke
Location
[4.5 - 12.7]
0.4
[0.2 - 0.9]
0.7
[0.4 - 1.3]
0.2
[0.1 - 0.5]
2.7
[1.4 - 4.9]
Anshan
Heart attack
54.6
[40.9 - 67.6]
62.1
Lung cancer
[47.7 - 74.6]
90.6
APPENDICES
Knowledge, Attitudes, and Perceptions
Ad at POS
Location
Anshan
Tobacco Marketing and Anti-Cigarette Messages
Erectile dysfunction
[82.9 - 95.0]
29.5
All four diseases
[20.2 - 40.7]
23.8
[15.2 - 35.2]
Beijing
11.8
[6.1 - 21.8]
0.9
[0.4 - 2.0]
2.6
[1.2 - 5.6]
0.4
[0.2 - 0.9]
3.9
[1.8 - 8.3]
Beijing
52.5
[45.0 - 59.9]
66.9
[58.8 - 74.1]
94.2
[92.5 - 95.6]
35.6
[29.1 - 42.6]
28.0
[21.9 - 35.1]
Changchun
11.3
[6.8 - 18.4]
1.4
[0.7 - 3.1]
1.6
[1.0 - 2.5]
0.4
[0.1 - 1.4]
2.6
[1.1 - 5.7]
Changchun
48.8
[39.6 - 58.1]
62.9
[53.4 - 71.6]
91.4
[85.5 - 95.0]
22.6
[14.2 - 33.9]
17.1
[11.0 - 25.8]
Haerbin
14.1
[9.2 - 21.1]
2.8
[1.6 - 4.6]
1.8
[0.9 - 3.8]
1.4
[0.6 - 3.2]
1.3
[0.6 - 2.9]
Haerbin
64.8
[56.1 - 72.7]
73.6
[65.9 - 80.1]
91.2
[86.3 - 94.5]
24.0
[15.4 - 35.3]
21.1
[13.2 - 32.0]
Hangzhou
10.9
[8.9 - 13.3]
1.1
[0.5 - 2.3]
0.8
[0.4 - 1.9]
0.3
[0.1 - 0.7]
1.3
[0.7 - 2.6]
Hangzhou
44.4
[39.4 - 49.6]
52.5
[45.9 - 58.9]
91.5
[88.5 - 93.8]
28.1
[21.9 - 35.4]
20.0
[15.1 - 26.0]
Kelamayi
7.9
[5.3 - 11.4]
0.9
[0.5 - 1.8]
1.1
[0.5 - 2.6]
0.3
[0.1 - 0.6]
1.7
[0.7 - 3.9]
Kelamayi
42.3
[34.2 - 50.7]
54.8
[45.8 - 63.4]
88.8
[80.4 - 93.9]
31.6
[23.8 - 40.5]
22.4
[16.4 - 29.8]
Lanzhou
9.1
[6.8 - 12.2]
2.0
[1.1 - 3.6]
1.0
[0.5 - 2.0]
0.6
[0.3 - 1.3]
1.4
[0.8 - 2.5]
Lanzhou
32.4
[23.6 - 42.7]
43.5
[32.4 - 55.3]
84.5
[62.6 - 94.7]
23.5
[15.4 - 34.3]
14.6
[9.5 - 21.8]
Luoyang
8.1
[5.5 - 11.7]
0.8
[0.3 - 2.4]
1.4
[0.6 - 3.0]
0.3
[0.1 - 1.6]
1.6
[0.9 - 2.8]
Luoyang
47.5
[39.5 - 55.6]
57.2
[48.3 - 65.6]
95.1
[93.2 - 96.5]
26.3
[18.5 - 36.0]
19.4
[13.5 - 27.2]
Nanchang
9.7
[7.0 - 13.3]
0.9
[0.4 - 1.6]
0.3
[0.1 - 1.2]
0.1
[0.0 - 0.3]
0.9
[0.4 - 1.9]
Nanchang
46.2
[41.9 - 50.6]
58.9
[55.5 - 62.2]
92.1
[89.9 - 93.9]
28.1
[24.6 - 31.8]
22.9
[19.4 - 26.9]
Qingdao
13.3
[6.0 - 26.9]
1.0
[0.5 - 2.1]
0.7
[0.3 - 1.6]
0.6
[0.3 - 1.1]
0.8
[0.3 - 2.4]
Qingdao
57.8
[47.7 - 67.3]
65.3
[55.2 - 74.3]
92.0
[87.6 - 94.9]
38.4
[27.0 - 51.2]
34.1
[23.3 - 46.9]
Shenyang
13.7
[8.6 - 21.1]
1.7
[0.8 - 3.4]
1.9
[0.8 - 4.6]
1.0
[0.2 - 4.1]
3.0
[1.3 - 6.7]
Shenyang
55.1
[43.5 - 66.2]
62.5
[50.9 - 72.9]
92.2
[88.9 - 94.6]
26.5
[17.8 - 37.5]
21.1
[13.0 - 32.4]
Shenzhen
9.5
[7.7 - 11.7]
1.1
[0.6 - 2.1]
1.3
[0.8 - 2.3]
0.6
[0.3 - 1.5]
2.8
[1.9 - 4.2]
Shenzhen
45.9
[39.5 - 52.4]
58.5
[50.9 - 65.6]
93.1
[90.3 - 95.2]
39.4
[31.6 - 47.8]
27.2
[20.0 - 35.8]
Tangshan
7.7
[5.2 - 11.2]
1.5
[0.8 - 2.8]
1.1
[0.6 - 2.0]
0.6
[0.2 - 1.3]
1.6
[0.5 - 4.9]
Tangshan
64.9
[54.3 - 74.2]
74.1
[65.4 - 81.2]
95.5
[92.6 - 97.3]
37.8
[26.9 - 50.2]
34.6
[23.8 - 47.3]
Tianjin
8.7
[6.2 - 12.0]
1.2
[0.5 - 2.7]
2.9
[1.4 - 6.2]
0.8
[0.3 - 2.4]
2.9
[1.8 - 4.7]
Tianjin
66.1
[56.2 - 74.8]
74.9
[67.6 - 81.1]
95.4
[93.2 - 96.8]
32.1
[23.0 - 42.9]
28.3
[19.1 - 39.6]
GATS 2010
Urban
4.9
[3.7 - 6.5]
0.8
[0.4 - 1.3]
0.8
[0.4 - 1.4]
0.0
[0.0 - 0.1]
1.1
[0.7 - 1.7]
GATS 2010
Urban
33.8
[29.1 - 38.7]
47.5
[43.3 - 51.8]
87.6
[85.5 - 89.5]
–
–
–
–
–: Data not available.
Knowledge, Attitudes, and Perceptions
Tobacco Marketing and Anti-Cigarette Messages
Percentage of adults who noticed cigarette promotion
in the past 30 days
(%, 95% CI)
Location
Items with cigarette brand
logos
Mail promotion
Percentage of adults who were aware of specific diseases caused by secondhand smoke
(%, 95% CI)
Percentage of adults who noticed anti-cigarette messages in the past 30 days
(%, 95% CI)
In newspapers/magazines
Anshan
0.2
[0.1 - 0.4]
0.2
[0.1 - 0.4]
51.7
[37.9 - 65.2]
Beijing
3.9
[0.9 - 15.3]
0.8
[0.3 - 2.1]
42.8
Changchun
1.4
[0.6 - 3.4]
0.4
[0.1 - 1.1]
41.6
Haerbin
1.7
[0.8 - 3.4]
1.0
[0.4 - 2.6]
Hangzhou
1.8
[1.2 - 2.7]
0.4
[0.2 - 0.8]
Kelamayi
0.8
[0.4 - 1.5]
0.2
Lanzhou
1.8
[0.9 - 3.5]
0.8
On TV
Location
Heart diseases in adults
[56.1 - 82.2]
Anshan
61.9
[48.2 - 74.0]
Either
Lung cancer in adults
89.0
Lung diseases in children
[82.7 - 93.2]
78.7
90.6
[88.8 - 92.1]
85.4
83.8
[74.9 - 89.9]
75.4
87.4
[81.9 - 91.4]
76.6
86.4
[84.5 - 88.2]
79.7
[73.8 - 88.9]
75.8
[66.8 - 83.0]
50.4
[41.7 - 59.2]
[62.2 - 92.8]
75.5
[59.1 - 86.9]
46.9
[35.3 - 58.8]
67.1
[52.7 - 78.9]
70.8
[36.4 - 49.5]
59.7
[53.6 - 65.5]
64.8
[58.6 - 70.6]
Beijing
66.3
[59.4 - 72.5]
[31.7 - 52.2]
55.0
[43.8 - 65.7]
58.1
[46.6 - 68.8]
Changchun
61.0
[51.8 - 69.5]
53.6
[45.4 - 61.5]
63.1
[53.3 - 72.0]
67.4
[58.7 - 75.1]
Haerbin
70.1
[61.6 - 77.5]
45.0
[38.3 - 52.0]
57.0
[49.2 - 64.5]
63.0
[53.7 - 71.5]
Hangzhou
52.6
[44.7 - 60.4]
[0.1 - 0.4]
52.0
[44.5 - 59.5]
73.4
[63.7 - 81.2]
75.5
[66.4 - 82.9]
Kelamayi
55.1
[46.1 - 63.8]
82.6
[0.3 - 2.0]
54.0
[42.6 - 65.0]
68.2
[54.8 - 79.1]
72.0
[59.2 - 82.0]
Lanzhou
49.9
[37.8 - 62.0]
82.1
[68.7 - 86.2]
All three diseases
59.0
[45.7 - 71.1]
[82.3 - 87.9]
62.8
[56.4 - 68.8]
[64.6 - 83.8]
55.2
[46.7 - 63.3]
[66.7 - 84.3]
62.7
[52.5 - 71.9]
[70.7 - 86.5]
49.6
[42.3 - 57.0]
Luoyang
1.0
[0.5 - 1.9]
0.4
[0.1 - 1.2]
56.5
[46.8 - 65.7]
68.7
[59.1 - 77.0]
74.6
[64.3 - 82.8]
Luoyang
57.3
[48.7 - 65.5]
86.5
[80.2 - 91.0]
80.0
[74.2 - 84.8]
50.9
[42.2 - 59.5]
Nanchang
1.6
[0.7 - 3.5]
0.1
[0.0 - 0.6]
41.8
[34.9 - 49.0]
58.4
[52.2 - 64.4]
63.3
[56.9 - 69.3]
Nanchang
62.7
[59.4 - 65.9]
85.2
[82.2 - 87.7]
81.8
[78.5 - 84.8]
58.0
[54.4 - 61.6]
Qingdao
0.7
[0.4 - 1.3]
0.6
[0.3 - 1.2]
43.8
[35.6 - 52.3]
59.2
[48.2 - 69.4]
63.1
[52.1 - 72.9]
Qingdao
64.3
[55.2 - 72.4]
87.2
[82.2 - 90.9]
79.2
[70.8 - 85.6]
58.9
[49.1 - 68.1]
Shenyang
0.6
[0.3 - 1.4]
6.0
[0.9 - 32.2]
43.1
[30.5 - 56.8]
57.2
[44.8 - 68.8]
62.4
[50.7 - 72.9]
Shenyang
58.3
[46.3 - 69.4]
86.3
[81.6 - 89.9]
74.8
[63.8 - 83.3]
54.8
[42.7 - 66.3]
Shenzhen
3.5
[1.7 - 7.2]
0.9
[0.5 - 1.9]
50.0
[43.5 - 56.5]
67.2
[61.3 - 72.7]
74.7
[69.3 - 79.3]
Shenzhen
59.2
[52.5 - 65.6]
85.8
[81.7 - 89.1]
80.6
[74.3 - 85.6]
53.9
[47.2 - 60.4]
Tangshan
2.6
[0.6 - 11.5]
0.6
[0.3 - 1.4]
57.2
[48.4 - 65.6]
72.0
[62.6 - 79.8]
75.4
[66.5 - 82.5]
Tangshan
73.6
[65.7 - 80.3]
92.7
[89.0 - 95.2]
87.2
[82.1 - 91.1]
70.5
[62.7 - 77.4]
Tianjin
1.4
[0.6 - 3.3]
0.5
[0.1 - 2.4]
46.2
[37.9 - 54.8]
61.8
[52.9 - 70.0]
64.6
[55.5 - 72.8]
Tianjin
74.3
[66.6 - 80.7]
90.7
[86.3 - 93.8]
83.0
[77.7 - 87.3]
70.4
[62.3 - 77.5]
[49.6 - 62.1]
GATS 2010
Urban
36.1
[31.9 - 40.5]
66.5
[62.6 - 70.1]
64.0
[59.8 - 68.0]
32.9
[28.6 - 37.5]
GATS 2010
Urban
0.9
[0.6 - 1.5]
0.0
[0.0 - 0.1]
30.3
46
[26.1 - 34.9]
49.2
[43.6 - 54.9]
55.9
47
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
Percentage of adults who believed low-tar cigarettes
less harmful than regular cigarettes (%, 95% CI)
Overall
Location
Current smoker
Percentage of adults who believed low-tar cigarettes less harmful
than regular cigarettes by education* (%, 95% CI)
Non-smoker
Primary school or less
Anshan
37.1
Beijing
33.5
[26.7 - 41.1]
46.7 [39.2 - 54.4]
29.7
[22.7 - 37.8]
Changchun
27.4
[21.9 - 33.6]
38.2 [28.2 - 49.2]
24.1
[18.6 - 30.6]
Haerbin
32.7
[23.2 - 43.9]
47.4
[33.4 - 61.8]
Hangzhou
40.5
[34.8 - 46.3]
52.0
[46.7 - 57.1]
Kelamayi
30.3
[23.9 - 37.7]
42.2 [32.2 - 52.9]
Lanzhou
31.5
[21.2 - 44.1]
Luoyang
28.6
[22.9 - 35.0]
48.9 [38.8 - 59.2] 22.5
Nanchang
42.7
[36.3 - 49.4]
54.3
Qingdao
36.0
[27.1 - 46.1]
Shenyang
36.1
[23.0 - 51.6]
Shenzhen
34.1
Tangshan
25.1
Tianjin
24.8
[17.3 - 34.3]
GATS 2010
Urban
41.8
[26.1 - 49.7]
Economics*
49.3 [36.2 - 62.5] 33.4 [22.7 - 46.3] 29.9
Secondary school
High school graduate
[15.7 - 49.3]
38.2
[25.1 - 53.3]
16.7
[9.8 - 26.9]
35.0
[22.8 - 49.6]
39.9
18.5
[11.9 - 27.6]
21.5
[16.2 - 28.0]
30.5
29.3 [20.3 - 40.2] 23.8
[15.2 - 35.2]
26.2
[17.2 - 37.7]
32.1
37.5
[31.4 - 43.9]
[13.1 - 31.5]
33.0
[26.4 - 40.3]
41.9
27.1
[20.8 - 34.6]
18.9
[12.0 - 28.5]
27.5
[20.5 - 35.7]
31.1
43.4 [28.4 - 59.8] 28.2
[18.4 - 40.5]
28.4
[15.9 - 45.4]
29.5
[16.5 - 47.0]
30.8
[17.0 - 29.0]
20.8
42.8
[31.4 - 55.0]
College graduate
or above
37.6
Median monthly expenditure on
manufactured cigarettes as percentage
of monthly dispensable income
per capita (%, 95% CI)
Median cost of 2,000 manufactured
cigarettes as percentage of GDP per
capita (%, 95% CI)
Overall
Overall
Location
(¥)
Overall
Overall
Estimated annual
GDP per capita**
(¥)
Overall
[25.7 - 51.1]
Anshan
7.1
[27.2 - 54.2]
35.8 [30.2 - 41.9]
Beijing
5.2
[4.6 - 6.8]
[22.7 - 39.7]
33.3 [26.8 - 40.7]
Changchun
8.1
[7.0 - 10.7]
[21.0 - 45.8]
38.9 [26.9 - 52.6]
Haerbin
8.5
[7.1 - 10.6]
2.2
[2.2 - 2.6]
4.8
[4.0 - 5.9]
25,197
45,010
[33.8 - 50.5]
44.8 [38.1 - 51.7]
Hangzhou
9.2
[8.2 - 11.0]
2.1
[2.1 - 2.1]
3.9
[3.4 - 4.6]
39,310
94,000
[22.1 - 41.9]
39.0 [33.0 - 45.3]
Kelamayi
6.8
[5.8 - 8.3]
0.4
[0.4 - 0.4]
0.8
[0.6 - 0.9]
25,249
227,115
[21.4 - 42.1]
37.5 [26.3 - 50.3]
Lanzhou
8.7
[6.3 - 8.8]
2.0
[1.9 - 3.1]
3.7
[2.6 - 3.7]
20,767
49,195
[6.8 - 8.6]
1.1
[0.9 - 1.2]
2.5
[2.4 - 3.1]
26,662
74,940
1.0
[1.0 - 1.1]
2.2
[2.0 - 2.9]
40,321
93,213
1.5
[1.5 - 1.5]
3.2
[2.7 - 4.2]
26,034
66,286
15.5
[9.9 - 23.4]
25.7
[19.0 - 33.8]
31.3
[24.4 - 39.2]
32.5 [25.9 - 39.9]
Luoyang
7.3
[6.7 - 11.1]
2.1
[2.1 - 2.1]
3.8
[3.5 - 5.8]
24,820
47,589
39.3 [32.2 - 46.9] 26.3
[19.4 - 34.7]
43.0
[36.0 - 50.4]
45.0
[36.1 - 54.2]
41.6 [35.3 - 48.2]
Nanchang
10.0
[9.1 - 12.7]
1.9
[1.5 - 2.0]
4.0
[3.6 - 5.1]
26,151
65,412
49.4 [36.4 - 62.5]
33.1
[24.4 - 43.2]
31.4
[22.3 - 42.2]
44.4
[33.9 - 55.4]
32.5
[23.0 - 43.7]
35.0 [23.3 - 48.9]
Qingdao
6.8
[5.2 - 8.2]
1.1
[1.1 - 1.1]
2.7
[2.0 - 3.2]
35,227
89,797
51.9
[36.4 - 67.0]
30.9
[18.4 - 47.1]
43.0
[21.3 - 67.8]
38.7
[22.1 - 58.5]
33.0
[20.6 - 48.2]
33.7 [21.0 - 49.2]
Shenyang
6.2
[6.0 - 7.5]
1.1
[0.9 - 1.1]
2.1
[2.0 - 2.5]
29,074
86,850
[28.6 - 40.1]
41.7
[34.2 - 49.7]
32.4
[26.7 - 38.6]
15.2
[9.7 - 23.1]
23.5
[15.7 - 33.5]
30.6
[23.9 - 38.3]
40.4 [31.7 - 49.7]
Shenzhen
5.9
[4.8 - 8.4]
1.1
[1.0 - 1.4]
1.9
[1.6 - 2.7]
44,653
137,477
[18.2 - 33.6]
38.7
[30.4 - 47.7]
21.5
[14.1 - 31.2]
15.5
[10.1 - 22.9]
26.7
[20.7 - 33.7]
29.1
[20.8 - 39.1]
29.8 [19.7 - 42.3]
Tangshan
8.0
[6.4 - 11.5]
1.2
[1.1 - 1.5]
2.6
[2.1 - 3.7]
26,647
82,605
34.1
[25.4 - 44.0] 22.2
[14.5 - 32.4]
18.1
[10.2 - 30.0]
22.7
[13.9 - 34.8]
27.3
[19.1 - 37.5]
27.6 [18.8 - 38.5]
Tianjin
5.5
[4.7 - 6.2]
0.9
[0.7 - 1.0]
1.8
[1.5 - 2.0]
32,658
101,689
46.5 [40.1 - 53.0]
GATS 2010
Urban
9.5
[8.1 - 9.5]
2.4
[2.1 - 3.3]
6.0
[5.2 - 6.1]
19,109***
[36.8 - 47.0]
60.1
[46.8 - 61.5]
[52.8 - 66.9] 35.4 [30.4 - 40.6]
27.4
[21.3 - 34.5]
45.2
[40.0 - 50.5]
45.7
[38.7 - 52.9]
*: Respondents age 25+.
*: Estimates are calculated with outliers removed.
**: Includes both urban and rural areas.
***: Source: National Bureau of Statistics of China. http://data.stats.gov.cn. Last accessed Jan 06, 2015.
Economics*
Median cost of 20 manufactured cigarettes
(¥)
Median monthly expenditure
on manufactured cigarettes (¥)
Median cost of 2,000 manufactured cigarettes
as percentage of dispensable income per capita
(%, 95% CI)
Overall
Overall
Overall
Location
Anshan
Estimated annual
Median monthly expenditure on
urban dispensable
manufactured cigarettes as percentage income per capita
of monthly GDP per capita (%, 95% CI)
8.0
[6.9 - 9.4]
158.2
[150.1 - 192.1]
3.0
[2.6 - 3.5]
Beijing
9.7
[9.6 - 9.9]
174.0
[155.2 - 228.3]
2.4
[2.4 - 2.5]
Changchun
9.9
[9.8 - 10.0]
174.6
[151.7 - 231.3]
3.8
[3.8 - 3.8]
Haerbin
10.0
[9.8 - 11.7]
179.4
[149.4 - 222.0]
4.0
[3.9 - 4.6]
Hangzhou
19.9
[19.9 - 20.0]
301.7
[269.1 - 361.5]
5.1
[5.1 - 5.1]
Kelamayi
9.7
[9.5 - 9.8]
144.0
[121.4 - 173.8]
3.8
[3.8 - 3.9]
Lanzhou
10.0
[9.6 - 15.4]
150.0
[108.4 - 152.1]
4.8
[4.6 - 7.4]
Luoyang
9.9
[9.9 - 10.0]
150.8
[137.6 - 230.2]
4.0
[4.0 - 4.0]
Nanchang
12.6
[10.0 - 12.8]
218.8
[197.5 - 277.2]
4.8
[3.8 - 4.9]
Qingdao
9.9
[9.7 - 10.0]
198.5
[151.9 - 239.7]
2.8
[2.8 - 2.8]
Shenyang
9.5
[7.9 - 9.7]
150.7
[146.5 - 182.5]
3.3
[2.7 - 3.4]
Shenzhen
14.9
[13.3 - 19.2]
220.6
[180.2 - 312.8]
3.3
[3.0 - 4.3]
Tangshan
9.7
[9.3 - 12.6]
178.3
[142.4 - 254.7]
3.7
[3.5 - 4.7]
Tianjin
9.5
[7.5 - 9.7]
148.5
[128.1 - 170.0]
2.9
[2.3 - 3.0]
GATS 2010
Urban
7.3
[6.2 - 9.8]
150.9
[128.9 - 152.1]
3.8
[3.3 - 5.1]
*: Estimates are calculated with outliers removed.
48
49
30,015***
APPENDICES
Knowledge, Attitudes, and Perceptions
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
III: Local Regulations on Smoking in Indoor Public Places
in the 14 Participating Cities, CCATS 2013–14
City
Survey date
District
City
Regulation/Legislation
Effective date
Type of Act
Anshan
Nov 2013 – Dec 2013
Tiedong, Tiexi, Lishan
Anshan
Anshan municipal ordinance on smoking control in public places
January 1, 2013
Ordinance
Beijing municipal legislation on tobacco control
June 1, 2015
Local legislation
Jun 2014 – Aug 2014
Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai, Shijingshan, Mentougou,
Fangshan, Daxing, Tongzhou, Shunyi, Changping , Pinggu, Huairou, Miyun, Yanqing
Beijing
Beijing
Changchun
Changchun municipal ordinance on preventing harms of tobacco smoke
March 1, 2014
Ordinance
Changchun
Nov 2013 – Jan 2014
Kuancheng, Erdao, Nanguan, Luyuan, Chaoyang
Haerbin
Haerbin municipal legislation on preventing secondhand tobacco smoke
May 31, 2012
Ordinance
Hangzhou
Hangzhou municipal legislation on smoking control in public places
March 1, 2010
Local legislation
Haerbin
Mar 2014 – May 2014
Daoli, Daowai, Nangang, Xiangfang
Kelamayi
Kelamayi municipal ordinance on banning smoking in public places
March 1, 2013
Local ordinance
Hangzhou
Mar 2014 – Jun 2014
Shangcheng, Xiacheng, Jianggan, Gongshu, Xihu
Lanzhou
Lanzhou municipal legislation on smoking control in public places
January 1, 2014
Local legislation
Kelamayi
Mar 2014 – Aug 2014
Kelamayi, Baijiantan, Dushanzi
Luoyang
–
–
–
Lanzhou
Dec 2013 – Mar 2014
Xigu, Anning, Chengguan, Qilihe
Nanchang
–
–
–
Qingdao
Qingdao municipal legislation on smoking control
September 1, 2013
Local legislation
Luoyang
Dec 2013 – Mar 2014
Jianxi, Xigong, Laochen, Chanhe
Shenyang
–
–
–
Nanchang
Nov 2013 – Dec 2013
Qingshanhu, Donghu, Xihu, Qingyunpu
Shenzhen
Shenzhen municipal legislation on smoking control
March 1, 2014
Local legislation
Qingdao
Apr 2014 – Jul 2014
Huangdao, Chengyang, Licang, Laoshan, Shibei, Shinan, Sifang
Tangshan
Tangshan municipal ordinance on managing harms of secondhand smoke
May 1, 2014
Ordinance
Tianjin
Tianjin municipal legislation on smoking control
May 31, 2012
Local legislation
Shenyang
Nov 2013 – Mar 2014
Heping, Shenhe, Tiexi, Dadong, Huanggu
Shenzhen
Mar 2014 – Apr 2014
Luohu, Baoan, Futian, Yantian, Nanshan, Longgang
Tangshan
Apr 2014 – Jul 2014
Lunan, Lubei
Tianjin
Dec 2013 – Mar 2014
Heping, Hexi, Nankai, Hebei, Hedong, Hongqiao, Tanggu
–: No current city-level regulations.
City
*: Coverage of the urban area is determined by local cities.
Indoor public places
Workplace
Restaurant
Bar/nightclub
Government
building/office
Health care
facility
Public
transportation
School*
University
Anshan
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Beijing
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Changchun
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Haerbin
Prohibited
Prohibited
Partially
prohibited
Hangzhou
Partially
prohibited
Partially
prohibited
Partially
prohibited
Partially
prohibited
Prohibited
Partially
prohibited
Prohibited
Partially
prohibited
Kelamayi
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Lanzhou
Prohibited
Partially
prohibited
Partially
prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Luoyang
–
–
–
–
–
–
–
–
Nanchang
–
–
–
–
–
–
–
–
Qingdao
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Shenyang
–
–
–
–
–
–
–
–
Shenzhen
Prohibited
Prohibited
Partially
prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Tangshan
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Partially
prohibited
Partially
prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Prohibited
Tianjin
*: Primary, secondary, and high schools, including technical schools.
–: No current regulations.
50
APPENDICES
II: Urban Areas Defined in the Survey in the 14 Participating Cities,
CCATS 2013–14*
51
REPORT OF CHINA CITY ADULT TOBACCO SURVEY 2013–14
References
Canadian Cancer Society. Cigarette package health warnings:
International status report, 4th edition, September 2014.
Human Services, Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health, 2012.
Eriksen M, Mackay J, Ross H. The tobacco atlas. Fourth ed.
Atlanta, GA: American Cancer Society; New York, NY: World
Lung Foundation; 2012.
U.S. Department of Health and Human Services. The health
consequences of smoking—50 years of progress: A report of
the Surgeon General. Atlanta, Georgia: U.S. Department of
Health and Human Services, Centers for Disease Control and
Prevention, National Center for Chronic Disease Prevention and
Health Promotion, Office on Smoking and Health; 2014.
Global Adult Tobacco Survey Collaborative Group. Global Adult
Tobacco Survey (GATS): Sample design manual, Version 2.0.
Atlanta, GA: Centers for Disease Control and Prevention; 2010.
Global Adult Tobacco Survey Collaborative Group. Global Adult
Tobacco Survey (GATS): Sample weights manual, Version 2.0.
Atlanta, GA: Centers for Disease Control and Prevention, 2010.
World Conference of Tobacco or Health. Factsheet 2. Smokefree Policies. 2015. Available from: www.wctoh.org/media/
wctoh-2015-press-kit/document/FS2-Smokefree-Policies-2015.
pdf (accessed March 25, 2015).
Global Adult Tobacco Survey Collaborative Group. Tobacco
Questions for Surveys: A subset of key questions from the
Global Adult Tobacco Survey (GATS), 2nd edition. Atlanta, GA:
Centers for Diseases Control and Prevention; 2011.
World Health Organization. WHO Framework Convention
on Tobacco Control. Geneva, Switzerland: World Health
Organization; 2003, updated 2004, 2005.
Jha P, Peto R. Global effects of smoking, of quitting, and of
taxing tobacco. N Engl J Med. 2014; 370 (1):60-68.
World Health Organization. WHO report on the global tobacco
epidemic, 2013: Enforcing bans on tobacco advertising,
promotion and sponsorship. Geneva, Switzerland: World Health
Organization; 2013.
Liu BQ, Peto R, Chen ZM. Emerging tobacco hazards in China:
1. Retrospective proportional mortality study of one million
deaths. BMJ. 1998; 317(7170):1411-22.
Ministry of Health, People’s Republic of China. Report on health
hazards caused by smoking in China. Beijing, China: People’s
Health Press; 2012
World Health Organization. Raising tax on tobacco – What you
need to know. May, 2014. Available from: http://apps.who.int/
iris/bitstream/10665/112841/1/ WHO_NMH_PND_14.2_eng.
pdf?ua=1 (accessed April 14, 2015).
National Cancer Institute. The role of the media in promoting
and reducing tobacco use. Tobacco Control Monograph No.
19. Bethesda, MD: U.S. Department of Health and Human
Services, National Institutes of Health, National Cancer Institute.
NIH Pub. No. 07-6242, June 2008.
World Health Organization. Electronic nicotine delivery systems.
WHO, Sixth session of the Conference of the Parties to the
WHO FCTC. July 2014. Available from: www.who.int/fctc/cop/
sessions/COP6_report_FINAL_04122014.pdf?ua=1 (accessed
February 10, 2015).
Redmon P, Koplan J, Eriksen M, et al. The role of cities in
reducing smoking in China. Int J Environ Res. Public Health.
2014; 11(10):10062-10075.
Yang GH, Wang Y, Zeng Y, et al. Rapid health transition in
China, 1990-2010: Findings from the Global Burden of Disease
Study 2010. Lancet. 2013; 381(9882):1987-2015.
Stead LF, Bergson G, Preciado N et al. Physician advice for
smoking cessation. Cochrane Database Syst Rev. 2013 May
31;5:CD000165.
Yang GH. Marketing ‘less harmful, low-tar’ cigarettes is a key
strategy of the industry to counter tobacco control in China. Tob
Control. 2014 Mar;23(2):167-72.
U.S. Department of Health and Human Services. The health
consequences of involuntary exposure to tobacco smoke: a
report of the Surgeon General. Atlanta, GA: U.S. Department of
Health and Human Services, Centers for Disease Control and
Prevention, Coordinating Center for Health Promotion, National
Center for Chronic Disease Prevention and Health Promotion,
Office on Smoking and Health; 2006.
Yang GH, Hu AG. Tobacco control and the future of China –
Expert evaluation of tobacco use and tobacco control in China.
Beijing, China: Economics Daily Press; 2011.
Yang GH. Global Adult Tobacco Survey (GATS) 2010 China
country report. Beijing, China: Three Gorges Publishing House;
2011.
U.S. Department of Health and Human Services. How tobacco
smoke causes disease: The biology and behavioral basis for
smoking-attributable disease: A report of the Surgeon General.
Atlanta, GA: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion, Office on
Smoking and Health; 2010.
Photo Credits
Page 1 dollarphotclub.com; 5 Beijing CDC; 7 reuters.com;
8 dollarphotclub.com; 9 iStockphoto.com;
11 dollarphotclub.com; 13 reuters.com; 15 reuters.com;
17 Lupei Du; 19 reuters.com; 20 Think Tank Research Center
for Health Development; 21 Tobacco Pack Surveillance System;
23 reuters.com; 26 Tobacco Pack Surveillance System;
27 reuters.com; 28 Beijing CDC; 29 reuters.com;
30 China CDC; 31 Kelamayi Institute of Health Education.
U.S. Department of Health and Human Services. Preventing
tobacco use among youth and young adults: A report of the
Surgeon General. Atlanta, GA: U.S. Department of Health and
52